First Do No Harm, Redux
The state is trying to shut down a New York City doctor’s ambitious plan to treat uninsured patients for around $1,000 a year.
Dr. John Muney offers his patients everything from mammograms to mole removal at his AMG Medical Group clinics, which operate in all five boroughs.
His patients agree to pay $79 a month for a year in return for unlimited office visits with a $10 co-pay.
But his plan landed him in the crosshairs of the state Insurance Department, which ordered him to drop his fixed-rate plan – which it claims is equivalent to an insurance policy.
Muney insists it is not insurance because it doesn’t cover anything that he can’t do in his offices, like complicated surgery. He points out his offices do not operate 24/7 so they can’t function like emergency rooms.
More. Dr. Muney’s idea is reminiscent of the minor health clinics Wal-Mart and CVS having been opening, though on a different scale.
People tend to think of the market as some kind of impersonal force (the ‘invisible hand’) pushing human beings around like pawns. The reality is that the market is millions of different people, each striving to improve their condition, exercising their creative potential, experimenting with different solutions to social problems. When one person hits on a better way to deal with a problem, others can copy this solution to the benefit of society. There is no need for everyone to accept the same solution if their needs and circumstances differ, nor is there any need to stick with a current way of doing things should a better way come along.
Government, however, tends to impede this process, imposing a one size fits all solution on society, and trying to block new ways of doing things that don’t fit its preconceived structures. Before cite the failures of the current system as a justification for greater government involvement in health care, they might consider applying an ancient piece of medical advice to government action: first, do no harm.
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Sigh. This sounds so riddled with the ideology of libealism: markets embody virtue, while big nasty governments mess things up. In reality, there are things the market can do fine, and there are things it cannot do so well. Health care is an area best not left to those whose goal is profit maximization. While private insurance schemes can offer great value to young healthy people, the absence of a cross-subsidy to those older and less healthy people leaves the latter group high and dry. It is an example of subsidiarity without solidarity. And social insurance is not the government trying to mess with all those virtuous atomistic agents, rather it is an attempt to coordinate people into a very efficient insurance scheme.
It would be nice if news organizations would link the controlling legal documents. The case is settled now: http://www.foxnews.com/story/0,2933,508990,00.html
My guess is that part of the problem related to this not being the only service he was running out of the facility. If we would have operated as a cooperative, there may not have been the issue. That is just my speculation though. There is however a real, real problem with pre-paid schemes impersonating insurance.
Does anyone have an actual reason that the government should try to block this doctor from helping people?
Sigh. This sounds so riddled with the ideology of libealism: markets embody virtue, while big nasty governments mess things up. In reality, there are things the market can do fine, and there are things it cannot do so well. Health care is an area best not left to those whose goal is profit maximization.
I find myself wondering, MM, if you think about stories like this at all before doing a mental cut and paste of your “health care doesn’t belong in a market” rhetoric.
What, after all, does “market” mean in this case. This doctor found a way to offer people a service that they very much wanted (affordable health care) and as a result of filling that very real need, he gained customers. Both he and they ended up better off for the exchange.
The problem that he’s running into is with the state’s definition of what constitutes charging for medical services versus what constitutes providing insurance: The state believes his plan runs afoul of the law because it promises to cover unplanned procedures – like treating a sudden ear infection – under a fixed rate. That’s something only a licensed insurance company can do.
Horrors! We wouldn’t want a poor mother with no insurance to be able to get her kid’s ear infection treated for only ten dollars! No, since it’s an unexpected treatment, she should have to pay more. The capitalist dog!
You then say, While private insurance schemes can offer great value to young healthy people, the absence of a cross-subsidy to those older and less healthy people leaves the latter group high and dry. It is an example of subsidiarity without solidarity.
This is an odd comment to make at this juncture, since what we’re seeing here is a doctor who is offering cheap services to the uninsured being shut down by the interests of the insurance industry. Nor does it seem like it’s necessarily the old who are being left out:
One of his patients, Matthew Robinson, 52, was furious to learn the state was interfering with the plan.
“The whole point is, he [Muney] found a way of paying his rent, paying his workers, and getting to see patients for the price,” said Robinson.
“How can the state dictate you’ve got to charge more?”
Honestly, I’m kind of befuddled by your reaction? Is this some kind of statist creative destruction doctrine whereby we should want to see all market attempts to provide everyone with basic healthcare thwarted in order to create enough pain to usher in the workers’ paradise of centralized health care? If what we as Catholics should care about is seeing everyone provided with basic medical care, I would think that we would be applauding Dr. Muney for making a valiant effort in that direction, and frustrated with the inflexibility of the state insurance commissioner, which apparently believes that if you don’t pay large sums for insurance, you should not be able to get affordable care.
The state believes his plan runs afoul of the law because it promises to cover unplanned procedures – like treating a sudden ear infection – under a fixed rate. That’s something only a licensed insurance company can do.
That’s the gloss of some mindless reporter. I wouldn’t take it as gospel.
And given that the settlement that you cited was that he would now how to charge a higher fee for everything but preventative care…?
The facts certainly seem to fit the “gloss of some mindless reporter”. Do you really find it so hard to believe that the state insurance commission would in fact in some ways watch out for the interests of the insurance industry as well as policing it?
:rolls eyes.
Is this some kind of statist creative destruction doctrine
I suspect it actually is. In the past, we’ve seen MM excuse the quasi-fascist aspects of the New Deal, in which government served the interests of big business by throwing small competitors in jail for the horrible crime of selling their products too cheaply.
:rolls eyes.
Look up George Stigler’s “theory of economic regulation.” It’s a classic.
While private insurance schemes can offer great value to young healthy people, the absence of a cross-subsidy to those older and less healthy people leaves the latter group high and dry.
Okay, so how about we provide a health care subsidy to the old (call it Medicare), and leave the provision of health care for everyone else to the market?
Okay, so how about we provide a health care subsidy to the old (call it Medicare), and leave the provision of health care for everyone else to the market?
40 million uninsured Americans wonder how you can ask that question with a straight face?
Looks like the good doctor may have an idea with some merit. A little investigation shows that his beef is 10 times more with the private market, namely the insurance companies, whose bureaucracy far exceeds anything that could ever be found in government, according to the doctor.
The doctor admits he has not yet figured out to make this a profitable business. I don’t know how complicated it is to get an insurance license, but the big issue is that if he is taking people’s money and promising them future benefits, he needs some reserves or the like to guard against people losing their money if he goes bankrupt or skips town. Given he is not making a profit, this seems to be a legitimate matter.
So, is health care some sort of a no-thought zone where pointing out that something other than either private insurance or a central government program (which also has the benefits of being local and cheap) might be a positive development is simply not allowed?
And there it’s absolutely beyond thought that state regulators might be acting in contradiction to the common good in this case?
Sheesh. Who knew it was so easy to be a dangerous mind…
Okay, so how about we provide a health care subsidy to the old (call it Medicare), and leave the provision of health care for everyone else to the market?
Thank you, Lyndon, I mean BA. Not a bad idea. It means abandoning a rigid private market philosophy and admiting the public sector has some role.
With that, we might (but don’t have to) consider a few other moderate steps. A public program for the low income disabled and dependent children. Some provision for health insurance for the unemployed, maybe as a part of Unemployment Insurance. For families with an able bodied, working head, a private market, employer provided system developed and negotiated by the employer and employee, or, in the case of a corporation and multiple employees, the employer’s chosen representative and the employee’s chosen representative.
Not perfect. But worth consideration.
The doctor admits he has not yet figured out to make this a profitable business. I don’t know how complicated it is to get an insurance license, but the big issue is that if he is taking people’s money and promising them future benefits, he needs some reserves or the like to guard against people losing their money if he goes bankrupt or skips town. Given he is not making a profit, this seems to be a legitimate matter.
Given that they’re only paying him $79 a month — I assume they could then take the step of not paying him anymore… It doesn’t say anything about him demanding the payment more than a month ahead. If he melts down, they’re not worse off than they were in the first place.
You’re right on the point that it’s insurance companies that he’s running up against as much as the government. But with a key modifier: As if often the case, the insurance companies have successfully persuaded the state (as happens not infrequently when big business and big government get together) that it’s in everyone’s interest not to allow someone like this to operate, thus essentially creating a buy-insurance-or-get-nothing situation.
Now as far as I can see, that restriction of the free market is effectively keeping these people from getting the most affordable basic health care at this point. Which doesn’t seem to me a good thing.
DC,
It that comment was directed to me, you really cheapened yourself.
Rather than whining about no-thought zones and cutting off debate, try re-reading my first sentence.
I then go to ask for more information on the difficulty and purpose of obtaining an insurance permit. No one has shown this is an impossible task, so at this point at least I don’t know the need for a permit is ‘shutting him down.’ It may be filling out an on-line form.
And yet, because of the excessive political influence business has, it is quite possible they have undue influence over this state agency. That is why I tend to be cool the political candidates favored by big business.
Darwin,
Why do you have this infallible belief that if government is involved it must be wrong? I told you already prepaid schemes masquerading as insurance were a real problem. Did it ever occur to you that regulations might be in place because they address actual real problems that have occured??? Do a google of “prepaid legal scams”. Do a google of “drug card scams” that use similar techniques. With this doctor you also have the issue of it being an insurance substitute. Some dumb schmuck says I can say $600 a month if I just use this guy. Besides, I can’t really afford real insurance anyway. If this doctor can do it, why can’t other companies? Heck we’ll create a shadow medical insurance market which we’ll save everyone millions (if not billions) of dollars. Oh wait, we have precedent for that! This whole sticking financial crisis was caused by a shadow banking system that didn’t want to have its profits and earnings restrained under the constraints of the real banking system.
Allowing interstate insurance sales would also go a long way towards creating a *real* market for med insurance.
No, it was aimed at MZ and Matt Talbot. We posted at the same time.
My second comment was aimed at you.
As you say, we’d have to research this, but I suspect one of the problems for him in regards to simply being licensed to be an insurance company is that then he’d be expected to cover everything. There are a number of regulations in place (at least in states in which I’ve lived) as to what an insurance plan must cover — and since he’s only covering what he can do in his clinics, what he’s doing doubtless wouldn’t qualify. What he’s really doing is a clinic membership plan where membership qualifies you for a low flat rate for all clinic services.
Pauli,
It has done wonders for credit cards, hasn’t it?
It has done wonders for credit cards, hasn’t it?
I don’t want to get bogged down in a side issue, but for purposes of the counter-example, I’ll say that I think allowing an interstate market for credit cards has, on balance, been a good thing.
As for the substantive issue, I’m afraid, M.Z., that I don’t quite understand what your position is here. Some of your comments seem to suggest that the article’s explanation of why Dr. Muney ran afoul of the state is incorrect or incomplete. Others seem to suppose that the story’s explanation is accurate, and that the good doctor had it coming. All of your comments evince a rather exasperated tone, as if you can’t be bothered to actually explain yourself. If you really can’t be bothered then that’s fine. Nobody’s forcing you to comment on this thread. But if you are going to comment I’d ask you to make more of an effort.
Why do you have this infallible belief that if government is involved it must be wrong? I told you already prepaid schemes masquerading as insurance were a real problem. Did it ever occur to you that regulations might be in place because they address actual real problems that have occured??? Do a google of “prepaid legal scams”. Do a google of “drug card scams” that use similar techniques.
I can’t really answer your first question, because I don’t have an infallible belief that if government is involved, it must be wrong. What I lack is a conviction that whatever government does must be right. Sometimes regulation is helpful, sometimes it’s actively unhelpful, sometimes is just a general drag of added inefficiency.
But in this case, it really sounds like there’s a fair amount of good and no harm in what this guy is offering. And so I don’t think it’s unreasonable to think it’s a problem if he’s being shut down by a regulatory agency.
Now on the other hand, maybe we just have very different ideas of how responsible people should be for not being stupid. Frankly, it seems to me that if someone cancels his 1200/mo Blue Cross plan and gets this doctor’s $79/mo membership instead — that person is doing something potentially unwise and should be held responsible for his actions, not have the doctor’s whole arrangement changed in order to protect the excessively foolish.
But then, back when BA posted about the excessively onerous lead testing requirements you came back with some anecdote about how someone might sell a pacifier decorated with lead crystals at a craft fair, so maybe we just have very different ideas of what problems we need to use government to fix versus what dangers people should be held responsible to navigate with their own common sense.
Having familiarity with my own state’s insurance regs, the explanation for the insurance regulator’s objection is incomplete to me. I checked the New York State Insurance Commissioners web site, and I could only find two documents referencing his name. I quick gloss didn’t suggest either were discussing this case. Generally it isn’t difficult bringing oneself up to regulation or moving outside said regulation.
Since it was suggested that insurance and its partner regulation weren’t important even it were the case that he were operating outside the law, I addressed the case as is. I don’t know what exactly troubled you about my explanation.
MZ — that comment is rather impenetrable. I did glean the point that you can’t find anything on the New York state website (neither could I), in which case it’s odd that your first comment was to blame the media for not “link[ing] the controlling legal documents.”
Assume there is choice and all our problems are solved. Wonderful. Children starving in Africa. Why don’t they choose to eat? Guy takes $79/m clinic vist plan versus $600/m (or whatever) comprehensive health plan, assume he doesn’t want comprehensive health. My goodness, we have solved the health care issue. People just need to choose health care treatment. Get me my Noble Prize.
DC,
Sorry if I over-reacted. I think we agree that the information we have is rather thin, but enough to merit additional investigation. The doctor may have soemthign useful, though it doesn’t solve the problem of lack of comprehensive health care access.
It would be a good discussion to have until its get hijacked by attacks on BA for honoring a doctor who does not support Catholic human life principles!
If the media would’ve linked them, I wouldn’t have had to waste time searching for them. I still haven’t found them. One would assume at some point the media actually saw them before writing the story.
Assume there is choice and all our problems are solved. Wonderful. Children starving in Africa. Why don’t they choose to eat? Guy takes $79/m clinic vist plan versus $600/m (or whatever) comprehensive health plan, assume he doesn’t want comprehensive health. My goodness, we have solved the health care issue. People just need to choose health care treatment. Get me my Noble Prize.
I’m not quite sure I follow your drift.
Is your point that since if given the choice (regardless of money) between a $600/mo comprehensive plan and a $79/mo limited clinic membership plan, that someone would obviously choose the former — that therefore having the latter available is in no way an improvement over lacking both because there is something better which in an ideal world people might have?
Okay, well…
I guess among other things, one of the senses in which this sort of structure strikes me as relevant is that it’s a low cost, local way of dealing with basic health care needs that the vast, vast majority of people could afford. If we made it easier to pair this kind of thing with coverage for high expense/hospital care kind of stuff that comes up once every few years (if at all), people would be pretty well taken care of and at a fraction of the cost of our current health care mess.
So while choice does not necessarily solve problems all on its own, an open market can allow useful solutions to appear. Not every good idea has to come from a technocrat in a Brussels (or DC) office.
Not every good idea has to come from a technocrat in a Brussels (or DC) office.
That’s true. If you are looking at what this doctor is trying to do as a national model, it seems similiar to an idea proposed by a guy named John Kerry in the 2004 Presidential race.
The USA is the strangest country. Innovative on the one hand and hopelessly behind on the other. Here, the battles of the 19th century are still being fought – from evolution to milking employees. Anywhere else, healthcare is a given, tied to the person, not a job. Conservatives even tend to view having plenty of vacation time as immoral.
I don’t know whether to laugh or cry. We get a story about a guy trying to respond to the atrocious health care system in the US. Instead of thinking about how this might be fixed, you guys are instead talking about how great this guy is. It’s like praising the ingenuity of the guy who starts using cigarettes as currency during hyperinaflation — shouldn’t the issue be first ending the hyperinflation? 40 million uninsured. Another 40 million underinsured. If you think these kinds of schemes are going to do anything to cure this crisis, you are living in libertarian la-la land.
Sigh, and here comes SB with his libertarian nonsense again. Praising the insight of George Stgler, godfather of the Chicago school, during the current financial crisis — well, that shows some chutzpah (actually, Stigler had one thing right: there is capture all right, but it is capture by the agents of deregulation — see Simon Johnson). And as for the NRA — as I’ve explained before, arguing that was bad policy is not the same as arguing that the government has no moral authority to regulate wages and prices, because it most assuredly has that authority.
And here comes MM again with a flurry of words that are all aimed at avoiding the point. The “current financial crisis” is completely irrelevant here (are you really trying to suggest that one alleged failure of regulation proves that agencies never over-regulate? How bizarrely illogical).
My reference at Stigler was merely a pointer to MZ, who seemed to be unfamiliar with the notion that regulatory agencies often end up being intertwined with the interests of large industries, and who couldn’t come up with any response better than “rolleyes.”
A book that MM would find enlightening: Clean Coal, Dirty Air, by Yale law prof Bruce Ackerman and William Hassler. Those guys are definitely not susceptible to any sort of prejudice against the “Chicago school.”
Actually, what we got was a story about a guy actually trying to find a solution to the problem he sees around him, and instead of at least recognising the guy’s contribution, we get some screed about how important it is that we all be forced through the same extruder.
That rigid, small mind of yours is an impediment to problem solving, MM.