Cash Only Medical Care – Coming Soon to a State Near You

11 Apr, 2013 John D'Alusio


The impact of the Affordable Care Act is just beginning to be felt. There is anything but a becalmed marketplace that is trying to determine how the law is supposed to operate on a daily basis, and its impact on consumers, the medical profession, and the overall economy.

Of course, the Affordable Care Act has been the center of an ongoing controversy revolving around “universal healthcare” in the United States. The law spans 2,500 pages. When Nancy Pelosi was asked about the contents before the law had passed Congress, she infamously answered, “We have to pass it to find out what's in it.” As bizarre as that answer was, that is exactly what transpired. 

There have been myriad prognostications about how the Affordable Care Act may affect Property/Casualty insurance. However, there has been a less of a dialogue about the potential peripheral results of the implementation of the new law.  

Dr. Jeffrey A. Singer practices general surgery in Phoenix, Arizona, and writes for Arizona Medicine, the journal of the Arizona Medical Association, Reason Magazine, and is treasurer of the U.S. Health Freedom Coalition, has added his voice the cacophony.  In a recent article he authored for Reason Magazine, Dr. Singer made a prediction that some viewed as somewhat fantastic, others as heresy, and still others as logical.

Dr. Singer opined that in the near future, as a result of the Affordable Care Act, a compact but vigorous market will materialize for cash-only, personalized, private medical care. Of course, this will essentially be a very exclusive club: you can't join without a surfeit of disposable income or savings.

Dr. Singer avers that “For those who can afford it, there will always be competitive, market-driven clinics, hospitals, surgicenters, and other arrangements – including “medical tourism,” whereby health care packages are offered at competitive rates in overseas medical centers.”

Now one must wonder why this type of “sub-culture” would be necessary when we are on the doorstep of a national healthcare program. According to Dr. Singer's way of thinking, the Affordable Care Act will ineluctably result in inefficient delivery of medical care. This will include “long lines, mediocre and impersonal medical care from shift-working providers, subtle but definite rationing, and slowly deteriorating outcomes.”

Don't fret. Those with the financial means will be able to secure fast, courteous, personalized state-of-the-art medical care from doctors who are dedicated to patient professionalism. If you're not in this small percentage of the US population, then now would be a good time to start fretting.

Why does Dr. Singer think this will occur? He astutely points across our northern border to Canada,  and across the “pond” to the UK. “We already see this in Canada, where cash-only clinics are beginning to spring up, and the UK, where a small but healthy private system exists side-by-side with the National Health Service, providing high-end, fee-for-service, private health care with little or no waiting” or care rationing.  

I still marvel at how the present Administration promulgated a wish to “fix” the US healthcare system, and then wound up in the midst of insurance reform, which has little to do with actual quality of care. Somewhere in the maelstrom of political infighting, endless debates, and politicians posturing for both internal and external consumption, the essence of the objective of improving affordable healthcare for the John Q. Public became lost.  

How all this is going to ultimately impact WC is anyone's guess. WC remains a “fee-for-service” industry, and a province of the states, rather than the politicos in DC. Still, some jurisdictions are investigating how to fold WC treatment into what essentially amounts to a single payer system.

In the final analysis, those of us who can afford to privately pay for state-of-the-art medical care are few and far between. Therefore, the vast majority of the populace will inevitably be subjected to the provisions of the Affordable Care Act.

My admonishment  to all those who hoped for the Affordable Care Act to be passed into law in its present form; be careful what you wish for. Unless you are a member of the rich, we are  going to be forced to live with the consequences of this legislation, and I (as well as Dr. Singer) am more than skeptical about the ultimate outcome.       


About the Author:

John D'AlusioJohn D'Alusio has over 30 years experience in P/C insurance with executive management positions in administration, field operations, and claim technical areas. Mr. D'Alusio has had many articles published in industry periodicals, and is also a contributing author to the LexisNexis published, “Complete Guide to Medicare Secondary Payer Compliance.”  He writes a monthly column for Risk & Insurance Magazine and is a quarterly columnist for AMComp Magazine.

His Risk & Insurance column is located at:

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