Senate hears concerns about health-care system

WASHINGTON — Some doctors who insist on payment at time of service — and refuse to deal with insurance or Medicare — say that actually saves their patients money or improves care, and sometimes both.

So Joint Economic Committee Chairman Bob Bennett, R-Utah, explored their claims in a hearing Wednesday. But Democrats charged that was part of a GOP plot to reduce workers' health care benefits to save their employers money.

"Today's hearing appears to be the next installment in the Republicans' push toward replacing traditional health care insurance with high-deductible health plans, also known as Health Savings Accounts (HSAs)," complained Rep. Pete Stark, D-Calif., ranking Democrat on Bennett's committee.

"This time the rationale for HSAs is that doctors can provide cheaper health care to patients if we do away with the insurance companies and their pesky paperwork," Stark said. He said such plans may tempt companies wanting to save money, but that "would likely undermine coverage that people receive through their jobs."

Bennett responded, "I can assure you, Mr. Stark, there is no conspiracy . . . to try to undermine the present system." He said he is trying "to take a fresh look" at everything to identify ways to curb spiraling costs or to improve care.

"I don't think there is anything affecting our economy more than rising health-care costs. I hear it from corporate executives as their No. 1 cost problem," Bennett said. "So I think it is appropriate that we look at every conceivable part of the system."

Robert Berry, a cash-only doctor who runs an emergency care clinic in Greeneville, Tenn., said he charges patients about half the price that Medicare would reimburse other doctors.

"The only way that I can keep my price so low is by avoiding the crushing overhead and hassles that other physicians allow third-party payers to impose on their practices," he said.

Bernard Kaminetsky is a cash-only doctor with a practice in Florida that caters to people who want doctors to spend more time on them, and are willing to pay for it. He limits his practice to 600 people to allow that extra focus. To afford that, he charges them $1,500 a year for access to him, plus costs for actual services.

"My patients are thrilled. I've rediscovered the intimacy that traditionally had been part of the doctor-patient relationship." He complained that low reimbursement from most insurance companies forces most doctors to offer only brief consultations so they can do more business, frustrating patients and doctors alike.