Doctors NOT taking insurance may actually be a good thing for healthcare!


Questioning Our Preconception of HealthCare

In an Aug. 23, 2014 Reuter’s article called, “‘I don’t take insurance’ not always a doctor deal breaker,” author Beth Pinker, explains how this typically plays out for a person seeking care.

As more and more people realize the extent of the funds they will need to spend before they gain access to insurance coverage — the average deductible is now $5000 — Physicians are waking up the fact that insurance and government reimbursements are too low for their “business” of medicine to survive. Recent numbers indicate that 40 to 50% — in some cases more — have already decided to opt out of insurance and move to so called concierge, i.e. retail, medicine.

The attraction for the physician is faster payment, and in most cases, a higher margin on the services performed. One of the big drivers is the total size of the pot of deductibles that will need to be spent for full insurance to kick in for the insured.

Some argue that the average deductible is not really $5000, that it is closer to $3000 per year. Still, with over 186 million insurance policies in the U.S. this lower estimate yields a total available market — called TAM by marketers —  of $500 billion that must be spent before insurance coverage kicks in. Any marketer will tell you, this makes desired value-based deductible retail healthcare one of the largest market opportunities out there.

It is not surprising that many doctors have already moved to some form of a retail model. Even physicians that feel they need to keep one foot in the reimbursement based model are exploring ways to augment this with more direct pay services. Companies like are helping physicians pave their way into a more sustainable healthcare service model. Many more are working with doctors to help them begin to manage their margin and mix of patients and find incremental revenues from historically unavailable sources.

Most physicians would be well served to take a look at these alternate revenue models and the evidence clearly shows most already have.In the long run, this is a good and necessary step. It portends the start of what likely will finally become an effective and efficient healthcare system.

For some, this may seem counter-intuitive but it is really the step that must be taken.  In the end, it will help set up a good basis for the additional evolutionary steps to design an effective and efficient system. A system that can provide assurance we have the resources to “Help the Helpless” while providing value-based choice for those who can afford more.  Most importantly, this will help provide a basis to integrate and manage the two economies through a common administrative system eliminating duplication of services, waste and fraud while bridging those in crisis together with all available resources necessary to treat their complete needs and provide comprehensive and fully coordinated care. By now, we all know this improves patient outcomes and lowers costs.

If your interested to learn more about why this is really a good trend and how such a system might look, you can go to


This entry was posted in General Comments, HealthCare Reform 2.0, Patient Protection and Affordable Care Act "ObamaCare" and tagged , , , , , , , by Thomas W. Loker. Bookmark the permalink.

About Thomas W. Loker

Meet the Author - Thomas Loker is a Startup Consultant and Advisor at SYDK.ORG, Angel Investor, Mentor and Advisor at Keiretsu Forum & Venture-Med and an established operations guy with serial successes with startups, transitional companies and turnaround situations. He has had a long career serving in the fields of science, technology and healthcare related industries. He is an active board member in both for-profit and not-for-profit companies. Tom has written numerous articles in the areas of healthcare, technology, politics and the economy. He is currently the principal author of Health Reform 2.0: Beyond partisan divide lies pragmatic solutions – a whitepaper focused on moving beyond the partisan rhetoric of the ACA (Obamacare) to a simple, efficient, effective, accessible and affordable healthcare system. He maintains a passion for serving the underserved and has founded, supported and worked in various companies to serve the most fragile among us. Because of his expertise on the business of healthcare, he was invited to conduct multiple congressional briefings on healthcare reform in Congress, meeting with more than 100 congressional representatives. He has been a guest on HuffPost Live to talk about health care issues, and is a frequent keynote speaker on the topic for many groups and events. Prior to his latest book, The History and Evolution of Healthcare in America: The untold backstory of where we've been, where we are, and why healthcare needs more reform, Tom published “Delusional Ravings of a Lunatic Mind”—a collection of essays on healthcare, politics and their interaction with the economy, available at Amazon, Barnes and Nobles, and other bookstores. Tom's passion for Music is currently expressed by his role as VP Operations and General Manager of David Victor Presents. See www, to find out more. You can find Tom online at: Website: Blog: LinkedIn: Photography:

1 thought on “Doctors NOT taking insurance may actually be a good thing for healthcare!

  1. Pingback: Doctors NOT taking insurance may actually be a good thing for healthcare! | The Journal of Retail Medicine

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