The Covert Rationing Blog

Black Market Medicine (Staying Off the Grid)

December 22nd, 2007 by DrRich

In a comment to DrRich’s latest post, Sam (a physician who gets it) points out yet another way subliminal healthcare rationing may be affecting consumers. He says,

DrRich,

I have become highly vigilant regarding my own health care. One reason for people to avoid using their health insurance is that they are trying to stay “off the grid.”

For example, I won’t call my car insurance company for a repair of a few thousand dollars simply for fear of establishing a high risk record. I think the same thing is happening with folks and their health insurance. Perhaps not for big ticket items but for smaller exams which might be fodder for benefits/policy denial, staying off the grid would be key.

Recently we changed insurance companys and received a letter requesting information on any out-of-pocket previous health expenditures (under our prior plan) that could be included in meeting our current yearly deductible. I told my wife to cease all forms of communications with the insurance company. Why would an insurance company care about my prior out of pocket expenses, and be so considerate to include out-of-pocket health expenses towards this year’s deductible, for expenses made prior to signing up? Can you say denial for pre-existing conditions? I am beginning to feel like a lawyer.

SAY NOTHING, SIGN NOTHING, DO NOT LET ANYONE RECORD A CONVERSATION. Paranoia is another symptom of being prey to health care rationing.

Staying off the grid. Sam is right; it is undoubtedly happening.

Which opens up a whole new business opportunity - Black Market Medicine. Doctors can offer “off the grid” services to people with health insurance who are reluctant to create paper (or database) trails. Is it time at last to spruce up all those boarded-up back-alley offices where illegal abortions were performed 40 years ago?

Perhaps all is not yet lost for frustrated, disaffected physicians and their appropriately paranoid patients. Opportunity awaits.

(Read the Second Installment of Black Market Medicine here.)

Posted in General Rationing Issues

6 Responses to “Black Market Medicine (Staying Off the Grid)”

1. Lisa Emrich wrote on 12/22/07 at 4:22 pm :

   I had not given much thought to the influence insurance companies have over our choices in healthcare.

   After being diagnosed with MS, my neurologist mentioned (during a newly-diagnosed support group meeting) that no information is truly private when a third party is involved.

   Until that point in time, I had never heard the terms ‘third-party payer’ or ’single-payer’ before.

   Also, my neurologist is one of those doctors resisting the move to electronic records where security nad privacy is still an issue.

   I guess to truly stay ‘off the grid’ doctor-patient records need to be inaccessable. Then, doctors would need to refrain from sending brief update notes to each other after patient visits (which my neurologist, rheumatologist, and internist do.)

   Personally, I appreciate that my individual doctors keep each other updated on my visits. However, that would have to end in a ‘black market’ system where communication becomes hush-hush.

2. DrRich wrote on 12/22/07 at 4:50 pm :

   Lisa,

   You are, of course, correct. Black market healthcare, like any black market economy, would carry a steep price from many standpoints.

   If you are new to this blog you may not realize that I often make suggestions that most rational people would find absurd if not insane. My point (usually) is not so much to suggest that these off-the-wall “solutions” are actually serviceable ideas, but instead to demonstrate how very absurd our healthcare system has become. (”It has become so absurd that even this seems like a good idea.”)

   Now. Having made this disclaimer, I am sadly forced to add the following: The behavior of health insurance companies, hiring armies of investigators (those very same people, in fact, who used to be employed setting up hidden cameras in private bedrooms and seedy motel rooms in order to catch cheating spouses) to find some excuse - any excuse - to retrospectively rescind the policies of subscribers who have become ill, has actually and truly made the insane notion of black market medical practices an idea worth considering.

   DrRich

3. SamEyeAm wrote on 12/23/07 at 8:44 pm :

   Dr. Rich, thank you for highlighting my posting on staying off the grid. As a physician I have been participating in this “Hydra” of modern healthcare but only since reading your blog have come to understand potential opportunities to deliver high quality care in a manner of my choosing. By understanding this augean system, physicians can manipulate the system to better serve their patients and themselves.

   A few years ago, I started caring for a fellow physician with a particularly rare severe form of glaucoma. He never used his insurance card always preferring to pay cash. That was my first experience with off the grid medicine. In his case to treat his first eye off the grid, I requested a demo office trial of two (costly) types of lasers. For his second eye the demo trial was not available so I scheduled him as a cash patient thru the hospital ambulatory surgical facillity. To his and my horror the facillity fee was thousands of dollars notwithstanding my conservative cash discounted surgeons fee. We looked at all options and came up with an alternate plan to stay off the grid. Since the physician was of Indian ethnicity, he traveled to India and paid 5000 Rupees for the glaucoma laser procedure for his fellow eye. When I asked him how much this was in US dollars he laughed and exclaimed about $150 US.

   Other patients stay off the grid in other unique ways. Two quick examples. Patient number 1 is younger, busy, and hmo insured. The hmo capitated plan funnels all patients to a large multiphysician single practice in my greater metropolitan area. The patient is horrified at the level of service, civility of the facillity, wait times, empathy of the physicians and fearfully projects all the above into possible post-operative result. I dont participate in the hmo so this is a cash patient for me. Patient number 2 is elderly, fragile, carries high degrees of co-morbidity and poses a complex difficult surgical case. The patient and family are distressed that the medicare hmo doctors keep cancelling and backpedaling on surgical treatment. Another cash patient for me.

   Dr. Rich there is another reason to resist the mediocrity trend of socialized rationed health care system and focus on excellence. Results talk, people talk and word of mouth fuels the black market driving and luring patients off the grid. Patients get frustrated, turn a need into a want and head to the black market. Unless designed as an exit strategy, physicians focusing on pure exclusionary concierge medicine are mistaken and will draw the wrath of the wonks and excluded patients unecessarily. Physicians need to concentrate not on concierge medicine but only on technical excellence, customer service, cost effective medical/surgical care (physician owned surgery center) and (sound business practices) cull the herd of insurance plans. The true unethical, amoral, avarice of advantage plans will do the rest. If you dont believe me just ask Angela Dispenza about her experience with health care rationing:

   http://abcnews.go.com/GMA/story?id=4039541&page=1

   She is off the grid by abandonment and default.

   SamEyeAm

4. james gaulte wrote on 12/27/07 at 5:56 pm :

   I may be making too fine a point on it all but it seems to me that black market activities is a subset of off the grid,namely the illegal subset.In any event it is expected behavior given rationing. I mused a bit about it on my blog today.

5. Dr. Val wrote on 12/27/07 at 10:18 pm :

   Concierge medicine = staying off the grid. My physician doesn’t accept insurance and offers reasonable and transparent fees. For $80/1hour office visit - I can afford to keep everything but major emergencies off the grid. www.doctokr.com

6. DrRich wrote on 12/28/07 at 11:36 am :

   Dr. Gaulte and Dr. Val,

   Thanks for your comments.

   Concierge medicine is a way of providing patients with a true medical advocate, a vital service that the traditional healthcare system is bent on destroying. So to that extent, it is at least a little subversive. But it doesn’t keep patients off the grid.

   In a concierge practice the physician still interfaces fully with the healthcare system. That is, the concierge doc still refers patients to specialists, orders tests from legitimate labs, and above all, keeps records. It would be difficult to really and truly “stay off the grid” by going to a concierge practitioner, as the patients’ medical records would still be carefully maintained, and would certainly be discoverable.

   Again, not to push too far a point that was meant to be at least somewhat tongue-in-cheek, when I say “Black Market” I really mean it. I mean back-alley, clandestine medical pratitioners who dispense medical services on the sly, keeping traceable records no more assiduously than did the old 1960s abortionists. And like the old illegal abortionists, this would be very bad medical practice, often harmful, most certainly illegal - and would fit the definition of Black Market.

   That the current system is dysfunctional enough that such a thing might soon become thinkable - and for the same reason illegal abortion was once thinkable, that is, because at least some patients were sufficiently desperate to demand the service - is my point.

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