Jewish World Review May 23, 2003 / 21 Iyar, 5763

Drs. Michael A. Glueck & Robert J. Cihak

The Medicine Men
JWR's Pundits
World Editorial
Cartoon Showcase

Mallard Fillmore

Michael Barone
Mona Charen
Linda Chavez
Ann Coulter
Greg Crosby
Larry Elder
Don Feder
Suzanne Fields
James Glassman
Paul Greenberg
Bob Greene
Betsy Hart
Nat Hentoff
David Horowitz
Marianne Jennings
Michael Kelly
Mort Kondracke
Ch. Krauthammer
Lawrence Kudlow
Dr. Laura
John Leo
Michelle Malkin
Jackie Mason
Chris Matthews
Michael Medved
Kathleen Parker
Wes Pruden
Sam Schulman
Amity Shlaes
Roger Simon
Tony Snow
Thomas Sowell
Cal Thomas
Jonathan S. Tobin
Ben Wattenberg
George Will
Bruce Williams
Walter Williams
Mort Zuckerman

Consumer Reports

Latest medical innovation: Cash | Every pundit in the land has his own diagnosis for the health care crisis du jour (pardon the French). Very often the diagnosis is a lack of adequate health insurance and the solution is more health insurance.

Perhaps this health insurance fever is the wrong diagnosis and what we really need is less insurance - not more!

Vern Cherewatenko, M.D., has reinvented this wheel. For which we should all be grateful. For this particular wheel - the quaint notion that patients might pay their doctors directly in exchange for the best service at the best price - has been sorely in need of reinvention.

Dr. Vern, a Seattle physician who once owned five paperwork-smothered family clinics and who ended up in professional and personal bankruptcy, calls this new wheel "SimpleCare" ( It saved his career.

Patients love it.

And the success illustrates a fact of health care life that the HMOs, insurance companies and bureaucrats don't want you to discover: A lot more wheels can be reinvented ... once we break the "Big Business and Big Government and Brainy Experts Are the Only Answers" mindset.

Four years ago, Dr. Vern's clinics were treating 75,000 patients a year. They were also losing nearly a million dollars a year. Inadequate reimbursements from insurance companies, rising overhead and - most of all - the escalating administrative and paperwork costs were destroying his life's work.

Then Dr. Vern and his partner, Dr. David MacDonald, had their epiphany. Make the patient, not the insurance company, the real customer again. So they set out to design and implement a system that would eliminate the cost and hassle of dealing with these bureaucratic sludge factories.

Under most present medical "insurance," the doctor and his staff spend seven minutes of administrative time to make proper records, code and bill for every minute of patient care (not even counting additional time when the insurance company denies or delays payment). Under the SimpleCare approach, there's no billing, only payment at time of service, and this ratio is reversed.

Most patients have never heard about "coding" or the thousands of CPT (Current Procedural Terminology) billing codes describing different medical services which the doctor has to put down on the insurance company paperwork. Insurance companies like these numbers because a clerk can punch them into a computer and identify what the company pays for the service.

There are also thousands of ICD-9-CM diagnosis codes. Plus HCPCS, MDC, DRG, CMS, DSM, GMLOS, AMLOS and RW numbers.

This alphanumeric zoo has caused creation of a new administrative medical subspecialty profession, the "coder," a person dedicated to digging up and writing down the Gestapo-correct code.

Few remember the times before World War II when fewer than 1 out of 10 Americans had ANY health insurance or medical plan other than cash. Some few remember when health insurance benefits became exempt from corporate income tax in the 1940s, meaning that a company could purchase health benefits for employees with before-tax dollars.

Both labor and management loved the idea of income-tax-free benefits, partly because income tax rates went up to 91 percent at the time. Today, about 85 percent of Americans now have some form of this "insurance."

But what we have come to call medical "insurance" isn't traditional insurance at all. It's actually pre-payment for a potentially limitless array of medical services, depending on need. Which means that those who get paid in advance to do nothing have every incentive to do exactly that and to deny or minimize care whenever possible.

When he started using the SimpleCare approach, Dr. Vern had three codes, Short, Medium and Long, for the length of the visit (10, 20 or 30 minutes, $35, $65 and $95), plus reasonable fees for specific procedures. Patients with insurance can then get reimbursement from their own insurance company.

Cash works because the patient has the incentive to get the best value for the money. And the doctor knows he has to provide the best value or he won't see that patient again.

"Ah yes," we can hear you saying, "all very fine for routine care or minor scrapes. But what about the big stuff?" To quote the president who supported and signed the original HMO Act of 1970: "I'm glad you asked me that question."

SimpleCare, or any of the variants now spreading across the country, does not take the place of all medical insurance, especially high-deductible medical insurance, as Dr. Vern preaches. This insurance starts paying when your medical spending gets over the deductible limit, typically several thousand dollars.

So tend to your high-deductible insurance, by all means. SimpleCare does not replace it. However, SimpleCare points toward further "unbundling" of health care services.

As most individuals and families have only routine medical care in any one year, they average saving hundreds and thousands each year when they buy high-deductible medical insurance and pay cash for routine services. Millions of Americans rediscover this truth for themselves when they start their own businesses and pay for their medical insurance and care themselves.

Many doctors all over the country already offer such services, some listed at In California, also try If you don't find the doctor you want on the list, try calling some of those listed for leads or referrals to other doctors who understand Cash and Carry.

Even if a doctor hasn't heard about the SimpleCare approach, you can use it whenever you want to pay cash. We recommend you tell the doctor that you want to pay cash and that you do not want any insurance billing. Then ask the doctor for his "best price" for his medical services only, not including insurance or delayed billing services. Remind the doctor that he won't have to wait months for payment or go through hassles with an insurance company. Many doctors respond with fees 20 percent to 50 percent lower than they charge for a combination of medical and billing services.

For most families - in sickness and in health - less insurance is better than more!

Why not sign-up for the daily JWR update. It's free. Just click here.

Michael Arnold Glueck, M.D., is a multiple award winning writer who comments on medical- legal issues. Robert J. Cihak, M.D., is past president of the Association of American Physicians and Surgeons. Both JWR contributors are Harvard trained diagnostic radiologists. Comment by clicking here.


05/09/03: We feel your pain; Physicians have it too no thanks to the DEA
05/02/03: Medical Quarterbacking
04/25/03: CNN the "Conscience-Not Network"
04/21/03: Medical Miranda?
04/11/03: Are childhood vaccines shots in the dark?
04/09/03: The PETA Principle -- The lambshank Redemption
03/28/03: American conscience?
03/21/03: West Wimps or Wings: Treatment for Hollywood Hypocrisy
03/13/03: Worldwide schmaltz shortage looms --- all because of a featherless chicken
03/06/03: Legal metastases are killing us
02/28/03: Outside the Jury Box: Seeking Justice rather than a Lottery in Medical Liability
02/21/03: Workforce temperature rising; employer TLC in demand
02/14/03: Malpractice Insurance: They Reap What They Sue
02/12/03: Hawk, Dove or Groundhog: Diagnosis Critical List; Prognosis Uncertain
02/07/03: How about tax cuts for the "rich" and "poor"?
01/31/03: AIDS Bug Chasers
01/24/03: Libertarian moment or movement?
01/17/03: It's not just 'sue the docs' anymore
01/03/03: A pox on the critics; diagnosis sour grapes
01/03/03: If protesting is good for your health; then at least let's root for the home team
12/20/02: Obesidemic (obesity epidemic) or not?
12/20/02: Time for voluntary informed smallpox vaccinations
12/13/02: The real reason the state opposes homeschooling?
12/06/02: Conscience of a former conservative: Portrait of a political metamorphosis
11/27/02: Thanksgiving dinner hazard?
11/22/02: Time to think outside the box and inside the nucleus
11/15/02: The military should be protected from abusive environmental laws in times of war
11/11/02: Does Kyoto Treaty pose more harm than global warming?
10/31/02: Deep thoughts on Baseball, the World Series and Life: How about them Anaheim Angels?
10/23/02: "Pediatric rule" guinea pigs
10/23/02: Once the World Series ends, we need to create a Donnie Moore Day of Remembrance: Sports and mental health
10/18/02: Congress to senior patients: Do as we say not as we do for ourselves
10/11/02: Using pollution "scare labeling" to political advantage
10/04/02: The Great Asbestos Heist: Did Litigation and Junk Medical Science Helped Bring Down the World Trade Center?
09/27/02: The imminent rise of civic feminism: A far healthier national alternative in war and peace
09/20/02: A Ray A Day" to replace the daily apple?
09/13/02: Beware of celebrities hawking drugs
09/06/02: Avoid 9/11 overdose: Give blood to begin "September of Service," SOS
08/28/02: From Doubleday to strikeday: Baseball's collective anxiety attack
08/23/02: Should she or shouldn't she?: An alternative view on treating menopause with HRT
08/16/02: Cooking up defenses against germ warfare
08/02/02: Medicine, crime and canines
07/26/02: Lies, pathologic lies and the Palestinians
07/19/02: Medicare Drug Follies as in "now you see it, now you don't"
07/12/02: Anti-Profiling: A New Medically False Belief System
07/08/02: Don't procrastinate, vaccinate!
06/28/02: The scientific advances on the safe and effective deployment of DDT are being ignored, or denied. Why?
06/21/02: Sex and the system: In seeking healthcare men are different from women
06/14/02: The FDA, drug companies and life-saving drugs: Who's the fox and who's the hen now?
06/07/02: Medical Privacy Lost: A hippo on the healthcare back!
05/24/02: To clean up America's game: A (soggy) ground rule
05/10/02: Free speech is good medicine
05/03/02: Medicine's Vietnam
04/26/02: Attack on alternative medicine could lead to alternative lawsuits
04/12/02: Insure the 'crazies'?
04/09/02: No Time for Litmus Tests: In War We Need a Surgeon General and NIH, CDC, and FDA Directors
04/02/02: The scoop on soot: A dirty rotten shame?
03/22/02: Too many beautiful minds to waste: The first annual Caduceus Movie
03/15/02: Terror and transformation: Defense essential for health & state of mind
03/08/02: Diagnosis: Delusional
03/06/02: The great matzah famine
03/01/02: Is new Hippocratic Oath hypocritical?
02/15/02: Why the recent moaning about cloning?
02/08/02: Searching for Dr. Strangelove
01/15/02: Score one for the value of human life
01/04/02: Medical-legal-financial wake-up call
12/28/01: Who's afraid of a 'dirty bomb'?
12/21/01: End of medicine?
12/14/01: More heroes: Docs deserve a little credit after 9/11
11/16/01: Do we need 'Super Smallpox Saturdays'?
11/09/01: Why the post-9-11 health care debate will never be the same
11/01/01: Common sense good for our mental health
10/26/01: Your right to medical privacy --- even in terror time
10/12/01: Failed immigration policy ultimately bad for nation's mental health: Enemy within leads to epidemic of jumpy nerves
09/28/01: Can legal leopards change their spots: A treat instead of a trick
09/21/01: Civil defense again a civic duty
08/30/01: Shut down this government CAFE
08/23/01: School Bells or Jail Cells?
08/15/01: Time to take coaches to the woodshed
08/10/01: Blood, Guts & Glory: The Stem of the Stem Cell controversy

© 2002