Surviving the Medical Meltdown (18 page)

There are several ways to employ a physician for cash. The easiest is to find a physician who is already set up to accept cash. There are three groups of these physicians: (1) conventional physicians who have “opted out” of the system and have strictly cash practices; (2) anti-aging physicians (also known as “integrative” or “complementary” physicians, who generally only work for cash; and (3) concierge physicians – think the TV show
Royal Pains
, about catering to the rich in the Hamptons. Not all concierge physicians are so highbrow. Many are affordable to middle-class people who want to prioritize health over other expenditures, such as the latest Ski-Doo.

CONVENTIONAL CASH PAY PRACTICE

If you are sick and need routine care, or if you are strapped for cash, you might seek out a conventional cash pay practice. Many of these can be found by calling around to physicians in your local area. But there are also resources such as the Association of American Physicians and Surgeons – an organization that promotes cash medicine (AAPSonline.org). For the names of cash physicians in your area, go to
aaps.wufoo.com/reports/m5p6z0/
. Other options are SimpleCare (SimpleCare.com), MediBid (Medibid.com), and DocCost (
Doc-Cost.com
). At the time I began this book, these cash-only physicians were few and far between. But in the last year, with the nightmare
of EMR and Obamacare, more and more docs are opting off the government plantation and opening cash practices. An added benefit to all cash practices – whether they are doctors or PAs or nurse practitioners – is privacy. They won’t be sending your most intimate medical information to bureaucrats in the federal government or to your insurance company.

ANTI-AGING PHYSICIANS

If you are well and have a little more money to spend, it may be best to seek out an anti-aging physician. The two big educational players in the field are Cenegenics and the American Academy of Anti-Aging Physicians. They both have websites to help you locate their physicians. The American Academy physicians are listed on WorldHealth.net, and Cenegenics-trained physicians can be found at
Cenegenics.com
. These doctors hold standard medical licenses but have joined the rapidly expanding group of physicians offering complementary or integrative medicine. Traditional government-compliant medicine demands strict adherence to conventional wisdom as revealed in the standard medical literature and teaching. This results in medical care that is out of date by the time it hits the paper or the government-approved algorithm, and you, the patient, receive medical care that is often twenty years out of date. In contrast, anti-aging, integrative physicians incorporate the latest science and clinical observation into their thinking. (See
chapter 3
, “Why Your Doctor Is Out of Date,” to understand this in more detail.) These are the guys who help you not get sick – as opposed to just bailing you out once you do! The downside is, many of these doctors do not want to be your “primary” physician but would rather just work on the wellness aspect of your health. I believe, however, that as things collapse, they will take on more and more of their patients’ needs.

FIVE THINGS TO LOOK FOR IN CHOOSING AN ANTI-AGING PHYSICIAN

1.
Do they recommend supplements?

2.
Do they balance all your hormones, not just the thyroid?

3.
Have they completed or are they pursuing postgraduate training in “anti-aging” or “integrative” or “complementary” medicine?

4.
Do they allot at least an hour for the initial visit?

5.
Do they do nutritional counseling?

WHAT TO AVOID IN CHOOSING AN ANTI-AGING DOCTOR:

1.
Ask if they use bioidentical hormones. If not, keep looking.

2.
Avoid university- or hospital-based or government-run health clinics. Look for independent, usually solo, cash physicians.

3.
Since physicians right out of residency have not been trained in anti-aging thinking, it’s best to find someone at least five years or more out in practice.

4.
Avoid physicians who do not appear healthy themselves. Is the doctor obese? Is he or she a smoker? You wouldn’t hire a home builder who lives in a falling-down shack; why trust a physician who is not following a healthy lifestyle?

CONCIERGE PHYSICIANS

“Concierge” physicians cater to high-end clients. If you can afford this level of “Cadillac” care, you are in good shape. They take cash. They usually practice high-quality medicine, and some, but not all, practice avant-garde anti-aging medicine. And they become your primary physician. You can access information about them by going
to their association website,
http://www.aapp.org/
. A link to the list of their member physicians is on their home page.

Judging physician quality is complicated. Some of the flashiest fast-talkers, with the best bedside manner, may not be up to date or, as they say, “the brightest bulb in the box.” On the other hand, I have known brilliant doctors and outstanding surgeons who were lousy in communicating with their patients. Just keep in mind the difference. It’s a problem of style and substance.

When choosing a concierge physician, you use the same criteria as you do for other physicians: look for someone who meets your needs and knows about your problem or what you want to accomplish, and ask around. How do that physician’s patients feel about him or her? Do you have friends who are nurses or doctors? What do they think? Even checking with others can be a problem. Every study looking at quality outcomes and patient satisfaction has shown that patient satisfaction is negatively related to quality outcome. In other words the worst outcomes were associated with better impressions of their doctors. It is unclear why this is true, but physicians are not there to be your friend, and “tough love” – insisting that you eat right, take medications, exercise, and so on – may not be as well received as the advice from a doctor who liberally hands out narcotic pain medications and tells you your health problem is not your fault.

Ultimately, you don’t know a physician until you try him or her out. With concierge medicine where a regular fee is required, make sure there is an exit clause. If you don’t like or trust the doctor, how does the contract get canceled?

All such care is threatened by the expansion of government medicine – in particular, Obamacare. Because people are not signing up in numbers to keep the program afloat, it is likely the government will use its eight-hundred-pound executive order sledgehammer and squash cash practices. They will do this by forcing all doctors into the government system. You the patient will probably not see this coming, as it will be done outside of Congress through administrative regulations. The Department of Health and Human Services
will most likely inform states that to keep their federal medical funding, they must insist that all physicians accept Medicare and Medicaid. The minute they do that, the small cash practices (which have run at low overhead and low patient cost) will not be able to function. They will have to hire office staff and add administrative suites and a computer system to bill the government. Then they will no longer be what you wanted when you sought them out – they will no longer be able to offer medicine that is independent, state-of-the-art, cost-effective, and personal.

FOUR THINGS TO KNOW ABOUT CONCIERGE PHYSICIANS

1.
Concierge physicians cost a premium but give premium service, including twenty-four-hour access.

2.
Some, but not all, concierge physicians are “integrative” or “anti-aging” physicians.

3.
Concierge physicians tend to be located in bigger cities.

4.
All concierge physicians take a direct, regular fee from patients for their premium service, but most then charge your insurance as well when care is rendered.

STANDARD PHYSICIANS

If none of these options is available, you may be able to negotiate cash prices with your current physician or another one in your area. At present, physicians are allowed to work for cash
if
the patient is not eligible for a government program (such as Medicare, Medicaid, or Tricare) and
if
the patient is not signed with an insurance program with which the doctor is contracted. In other words, if you are now on Medicare, you have lost the right to contract privately with a physician unless that physician has formally “opted out” of the Medicare system. If you are legally able to pay cash,
do not accept the
standard fees
. Standard fees are set to compensate for the enormous hassle of paperwork and waiting months to years to get paid by third parties. When you pay cash, the doctor gets a big break and should be able to pass this off to you. But you may have to convince him. Also, unless he has formally opted out from Medicare, he cannot legally charge you less than Medicare-allowable rates, even if you are not of Medicare age.

DOC IN A BOX

Go to many malls or Walmart–type stores and you will see cash clinics run by doctors or nurse practitioners. These offer low-level care for many routine matters, and they are cost-effective. In our Obamacare environment, these “Doc in a Box” shops are becoming more appealing to physicians and patients. They are not generally for long-term care of chronic illness; but for those who are generally well, they provide the kind of care the old-time country docs did – no frills or fancy testing, but quick fixes for many problems. In some of these shops, by charging cash at the time of service, they avoid all the hassles of inefficient electronic medical records mandated by the government. They can provide good quality for cost because they don’t have to factor in the cost of complicated billing (estimated at fifty-eight dollars a bill). And they are not hindered by the thousands and thousands of pages of Medicare and Obamacare regulations, which demand – among other things – data collection on aspects of a person’s life and health that are completely extraneous to the matter at hand.

HIRE YOUR OWN DOCTOR

Rich people have always had the means to hire their own “private” physician. But why not extend this concept to a group of average people? Let’s say there are no cash doctors in a town of a thousand people. As the system collapses, patients have to travel farther and farther for care, and ultimately it becomes unavailable. If each of
these people chipped in two hundred dollars and were then willing to pay a small fee per visit, the group could have a private physician all to themselves. The physician, no longer under government pay and rules, could run an old-time, cost-effective office, and the people could have easy access to local care. I used dollar amounts in this scenario, but remember that in an economic collapse everyone is affected – doctors too. So these numbers are just hypothetical, based on today’s going rates.

FIND MID-LEVEL PROVIDERS

There is no question that physicians – MDs and DOs – have much more training than the “mid-level providers” – nurse practitioners, nurse midwives, and physician’s assistants. But for everyday care these mid-level guys are great. And in the current environment, where doctors are scarce, these providers are taking up a great deal of slack in rural areas, where people would otherwise have no care. It has been my observation that mid-levels find their niche, and they really perfect that niche. I worked for many years with a PA doing nothing but spine surgery. Besides bringing a great deal of maturity and life experience to the job – he used to set himself on fire daily as a welder before becoming a PA – he became an expert at diagnosing and outlining treatment for patients with spinal stenosis. He would frequently see patients who had been through four or five specialists with extensive and costly workup, only to figure out their problem in a few minutes of careful history and exam.

Of course, these mid-levels function best in an environment where they can get quick curbside consults, as needed, from physicians in the building or nearby, and that may not be possible in the future. Nevertheless, they generally are well trained, use good common sense, and have years of experience in some area of medical delivery. I routinely see a nurse practitioner for my yearly Pap smear and minor needs. Everything mentioned about cash practices and hiring a physician could be applied to these providers. Just like
automobiles or violins, they cost less and you get less (in this case, knowledge and technical training), but then again, how many of us buy a Bugatti to get us from point A to point B when we can buy a very nice, cheaper Nissan that gets the job done?

Ultimately, there are people with some medical training who live near you. Get to know who they are – the emergency medical techs, the former military medics, the licensed practical nurses, and the registered nurses. Get to know your neighbors. Attend the fire and rescue charity event. Volunteer at the blood drive or the hospital. Anyone with some knowledge may be able to help in some circumstances. Before government became our safety net, our communities were our sources for help. They will be again. It is good to have a skill to trade for someone else’s medical skill or some negotiable item to trade – currency or food or bullets. Who knows what it will be? But talk to those around you and learn where your resources are.

When the Supreme Court sold out liberty by accepting the
constitutionality of Obamacare, people all around the country contacted me for comment. In response, I sent out a picture of me in surgical scrubs, standing on the side of the road with my dad’s old, black doctor’s bag, holding a cardboard sign that read, “Will Do Surgery for Food.” And it may come to that. I am stocking up a home office for the possibility.