“Coverage” Isn’t “Care”

by G. Keith Smith, M.D.  

If you are following health-related topics on social media you have likely encountered “coverage is not care,” as a theme or #hashtag. This phrase/quip should be viewed as an opportunity and lens through which the dysfunction of the crony-dominated “healthcare system” in this country can be viewed.

Not only is “coverage” not equivalent to “care,” “coverage” can and many times does create a barrier to care.

It might shock you to learn that the “cash” price for many medications at your local pharmacy is less than the co-pay if you are using your “coverage” to buy these same medications. In other words, you are better off claiming to be uninsured when you buy certain pharmaceuticals! Why is this? Your “coverage” represents an additional, contracted layer—a toll booth—through which the exchange between you and the pharmacist must take place. This toll to pharmacy benefit companies/wholesalers is removed from the purchase if you represent yourself as uninsured. The presence of this middleman/distributor can and does increase the price of pharmaceuticals dramatically, representing as much as 50% of the purchase price for a large number of medications.

The same goes for the care at many physician offices. Any physician who is contracted with insurance companies labors under their fee schedules, any departure from which risks expulsion from the “network.” Physicians who waive all or part of deductibles for patients or treat cash-strapped patients free of charge run the risk of running afoul of these same “network” contracts and may also face legal action. What gives?

Waiving deductibles or co-pays for those short on funds lowers the barrier upon which the insurance carriers rely to protect their own corporate wallets. After all, a patient who cannot muster their deductible represents little or no financial risk to those providing the “coverage,” and the higher the deductible—or barrier to care, the greater the likelihood the “insurance” companies will pay nothing at all. The courts have been no friend to those well-intentioned physicians and facilities that have waived deductibles/co-pays in an attempt to help their patients. Once again, if you have “coverage” and are low on funds, you should always ask the “cash” price for a service before revealing that you actually have “coverage.”

Do you have “coverage” and have no trouble meeting your deductible? Do you therefore think you can safely access the care that you need? Think again. “Insurance” companies employ hidden techniques that deny various types of care to those who have “coverage.” Intentionally paying physicians below an acceptable rate for certain treatments and procedures serves as a powerful rationing tool, leaving certain treatments in short supply. Moreover, if a treatment is theoretically “covered” but is denied in your case, say because the insurer deems it “unnecessary” or “inappropriate,” the physician cannot accept payment from you because of the “hold harmless” clause in his provider contract. Thus, he must either provide the care at his own expense, or agree with the insurer that you shouldn’t get it.

Perhaps the only gift of Obamacare was that the deductibles were very high and very few physicians or facilities actually signed contracts with these plans. This created a vigorous cash market, where patients who are “covered” but without benefit, could negotiate cash prices with physicians and facilities for the care they needed. At the Surgery Center of Oklahoma we continue to see a large number of patients who are attracted to the pricing on our website (www.surgerycenterok.com) that is a fraction of their Obamacare or other “coverage” deductible.

Fans of “universal coverage” should keep in mind the countless “covered” Canadians who buy their care in the U.S. or overseas due to long access lines. Canadian provinces balance their budgets by stringing patients out on long time lines, extracting a painful and merciless “time tax” from their citizenry. Fans of “Medicare for all” should know that while violating a private “insurance” contract can be a hassle for their physician, violating the terms of a contract with Medicare is a crime. Unless a physician has opted out of Medicare he is not at liberty to waive deductibles or co-pays or charge less than the amount Medicare allows. In short, Medicare has criminalized charity, as demonstrated in a recent case of a Medicare beneficiary with a broken ankle who is stuck in a wheelchair because she can’t come up with her $2,000 deductible.

Leave it to government to force the purchase of this “coverage.” All who have been victimized by this cronyism have earned a seat on the #metoo bandwagon.

Anesthesiologist Dr. G. Keith Smith serves as the medical director, CEO and managing partner of a “free market” outpatient surgery center in Oklahoma City, while also maintaining an active private practice.

Dr. G. Keith Smith is the co-founder of the Surgery Center of Oklahoma, one of the few medical facilities in America that openly posts the prices of its surgeries on its website. The fee-for-service medical facility is devoted to delivering top-rate care at a fraction of what conventional hospitals charge.

When Dr. G. Keith Smith launched the first website displaying all-inclusive pricing for various surgical procedures in 2009 it attracted national and even international attention for him and the Oklahoma medical treatment facility, which is owned and operated by around forty of the top physicians and surgeons in central Oklahoma.

Since then, many Canadians and uninsured Americans have taken full advantage of the low and transparent pricing available at the surgical treatment center.

The operation of this free market medical practice, arguably the only one of its kind in the U.S., has also garnered the endorsement of policymakers and legislators across the nation.

The Surgery Center of Oklahoma’s consumer-driven model could well become increasingly more common as Americans look for alternatives to the traditional health care market in the face of higher costs and reduced access to doctors and hospitals under the Affordable Care Act.

Dr. Keith Smith, co-founder of the Surgery Center of Oklahoma, explained to Bill O’Reilly (The O’Reilly Factor) how patients across North America have grown increasingly tired of waiting in line for prohibitively expensive medical treatment and will naturally gravitate towards lower-cost, higher-quality medical care available from physicians and facilities outside of ObamaCare.

Self-funded insurance plans are already taking advantage of Dr. Keith Smith’s medical services pricing model in greater numbers, resulting in significant savings to their employee health plans.

Dr. Keith Smith believes that the healthcare system is perversely designed to keep Americans paying higher and higher prices while subsidizing huge corporate-controlled hospitals with tax dollars obtained through their fictional not-for-profit status.

Dr. Keith Smith took the opportunity to discuss with John Stossel just how these “non-profit” hospitals and insurance companies drive up the cost of care by practicing dishonesty in pricing.

Dr. G. Keith Smith hopes that as many medical treatment facilities as possible adopt a similar transparent pricing model, a move he believes will lower healthcare costs for all and improve quality of patient care.

To encourage widespread adoption of his proven methods amongst the medical profession, Dr. G. Keith Smith co-founded the Free Market Medical Association so as to revolutionize managed medical care through treatment cost transparency.

Interviews and Videos featuring Dr. G. Keith Smith of Oklahoma

Dr. Keith Smith has made appearances on the John Stossel Show, CNBC, Huffington Post, Capital Account with Lauren Lyster, the Ron Paul Channel and has been featured by Reason Magazine’s TV division and NBC affiliate, KFOR. The New York Times, ABC news, Forbes and many others have written articles featuring Dr. Smith’s revolutionary approach to the pricing of health care and uncompromising free market principles.

Episodes featuring Dr. G. Keith Smith on the Surgery Center of Oklahoma YouTube video channel.

Co-Founder of the Free Market Medical Association, Dr. G. Keith Smith, discusses the free market healthcare movement at the Free Market Medical Association‘s 2014 Annual Conference.

Interview of Dr. Keith Smith on the Mickey Ellison Show.

Dispatch Radio’s Robert Herriman interviews Dr. G. Keith Smith with the Surgical Center of Oklahoma.

G. Keith Smith MD talks to Lew Rockwell on Vision Liberty about the wild success, and low prices, that result from kicking the feds out of healthcare. 10/13

Feedback audio http://wsau.com/podcasts/feedback/dr-g-keith-smith-surgery-center-ok/ 7/12

Dr. Keith Smith discuss free market health care on CNBC’s Street Signs. 8/14

Dr. Keith Smith of the Surgery Center of Oklahoma on Fox News. 8/13