Even Rand Paul’s Obamacare “Repeal and Replace” Is Utter Bullshit. Cash

What Happens When Doctors Only Take Cash

When Art Villa found out, after one too many boating accidents, that he needed a total knee replacement, he began asking around to see how much it would cost. The hospital near his home in Helena, Mont., would charge $40,000 for the procedure, he says. But that didn’t include the anesthesiologist’s fee, physical therapy or a stay at a rehabilitation center afterward. A 2015 Blue Cross Blue Shield study found that one hospital in Dallas billed $16,772 for a knee replacement while another in the same area charged $61,585.

It was in the midst of this confounding research that Villa, who’s 68, heard about the Surgery Center of Oklahoma, whose business model is different from that of most hospitals. There, the all-inclusive price for every operation is listed on the website. A rotator-cuff repair for the shoulder costs $8,260. A surgical procedure for carpal tunnel syndrome is $2,750. Setting and casting a basic broken leg: $1,925.

The catch is that the whole facility is cash-based. It doesn’t take insurance of any kind. Not Aetna. Not Cigna. Not Medicare or Medicaid. Patients or their employers pay whatever price is listed online, period. There are no negotiated rates, no third-party reimbursements and almost no paperwork. “We say, ‘Here’s the price. Here’s what you’re getting. Here’s your bill,'” says Keith Smith, who co-founded the Surgery Center in 1997 with fellow anesthesiologist Steven Lantier. “It’s as simple as that.”

Fuck Rand Paul, and fuck “libertarians.”


  1. poop monster on January 27, 2017 at 12:48

    Total Knee Arthroplasty (Knee Replacement) $15,550

    • Rob on January 27, 2017 at 17:15

      Until there is transparency in pricing, direct pay, incentive for preventative medicine and a whack a mole approach to the drug industry, all efforts are simply rearranging the deck chairs on the Titanic.

  2. Ken on January 28, 2017 at 00:02

    This is generally a good news post, however after decades of sick care, any plan has to take into consideration the fatties and sickies it has produced. As much as we’d like to disdain them and sneer, the truth is, people who have 100+ lbs to lose, people with chronic EBV, people with c. diff from decades of antibiotic use, the old who just want a few more years to see their grandkids, and have been criminally over-medicated – often with two or three bp meds at once, the lack of enterovirus vaccine research (the new polios that break out occasionally) that leads to the death of children or permanent weakness, the MS and fibro women (and men) who already maintain their function using alternative means bc nothing else helps, Lyme disease, ALS, etc…. (I haven’t even touched on arthritis, copd, cancer, or mental health.)

    These are not going to be solved by accident only care. However good the cash for service model is, it’s not a comprehensive solution yet. With more work, the kinks can be worked out, but you should consider that some people didn’t hear about any effective means of regaining their health until about a decade ago. Even if the whole country went Paleo and started lifting weights for rehab, and the elderly were taken off unneeded drugs, it would still be two decades before we’d see how effective that is for chronic illnesses,and all the while people would resist, saying rightly that the evidence is mainly anecdotal.

    And it assumes people can afford to pay. How many walmart cashiers have $15k saved up for a potential accident? This assumes they are also participating in sports (not just the middle class) that could lead to a knee reconstruction. If we all embrace it, then so do they.

    I don’t think this is a bad idea, I think it’s a good start, but be realistic about the speed of the change. I fell victim to copd due to a drug that had a side effect that ultimately damaged my lungs. Weight lifting is the first time I’ve enjoyed training since before I was hospitalized. It’s too easy to dismiss copd as something only smokers get. I hope I never need oxygen and so far I’ve managed it without the need for extreme measures. But I would be dishonest if I claimed I would never need it.

    When I first found out, I did a lot of research, and found cheap devices that I could optionally use to better my lung function. Doctors didn’t tell me about it. That’s what’s wrong, it should’ve been the central focus of my care, but the system is geared to make you pay for expensive inhalers instead. However if we switched now, instantly away from inhalers and toward simple cheap devices, the patients would rebel.

    Look what happened with CFS, the patients rebelled against the graded activity plan (anecdotally, it works), and are insisting we look for an organic cause. Sadly they’re both true, the organic cause probably is a virus, but medicine refuses to seek it and make a vaccine bc idiopathic CFS is one reason that people sometimes get disability, and having an organic cause with no vaccine would give 50% or more of the population a reason to apply. In medicine it’s heresy right now to connect EBV with CFS, but the heresy is political, not medical.

    It’s not as simple as going to cash unless you have policy analysts to take all these issues into account. I hope this kind of change does take place – provided the messy contingencies are planned for. The money we’re wasting with the insurance and inflated price system is nuts.Already I buy only from locally owned compunding pharmacies if I need a drug and their prices are about the same as the legal online pharmacies. If I ask at Rite Aid, the price for no-insurance is about 500% or more of the local pharmacy.

    The savings could be stellar if we abandoned all forms of insurance, but if it stopped now, the moms with breast cancer would suffer an impossible cost for some forms of care. And if you think that someone hurting a puppy is unpopular, just wait and see the backlash of hurting working moms with breast cancer. If you really want the savings, the plan has to provide for cases where the savings will not help much.

    IDK where I stand politically anymore, I surprised myself by agreeing with Trump’s plan for extreme vetting and prioritizing Christians. I see nothing wrong with selecting refugees instead of acting as if they’re all entitled because there is a war. But there are things happening I don’t like also. I think reality is more like the scrollwork on a gingerbread house, than the square simplicity of a brick house. I wonder sometimes what would happen if we forced health care not to offer two prices for service – double pricing is not only wrong but I thought it was illegal. Maybe that would fix the leaks as well as a cash system. I wish I were better at finance and economics, but I have limits.

    • Woodchuck Pirate on February 2, 2017 at 09:32


      Thank you for sharing your insights and emotions. However, I have two points regarding the fatal underlying assumptions of your post:

      1) If you are making a case for charity it diminishes your credibility when you strategically avoid stating your “request for charity”. In fact it underscores your entitlement mentality of initiating aggression against individuals. Petitioning the brute force of gov’t to take what you want from others in order to fund so-called noble deeds is not charity, it is theft. Charity remains the legitimate venue of family and church.

      2) In a truly free society if you want to do charitable deeds, nobody will stop you. Those that reject freedom should suffer from their own self-victimization; people that don’t respect their own rights will violate the rights of others. This is where you stand and you are correct in recognizing that your stance is not sustainable, neither should it be. Man up or get your ovaries checked. How many people are going to die from your aggression against real freedom?

      Woodchuck Pirate
      aka Raymond J Raupers Jr USA

  3. Bret on January 28, 2017 at 06:01

    There’s nothing to “replace” damn it. Only lots of cuts to policy, including undoing tax incentives that owe to Depression-era wage controls.

    No more government payer health care (or “insurance”), and get rid of all the tax code stuff that deals at all with employer-provided insurance or care.

    This will rightly get 99% of employers out of the equation, patients will become customers, and prices will fall off a cliff.

    Of course it is useless to say “will,” because that will not happen. Even Republicans seem to think a federal health care policy is something we need. The stupidity is ingrained deep and wide.

    People are scared of sickness and death, just like they’re scared of flying. Fear means lots of government interference, which means more fear, higher costs, lower quality, and endless squabbling over who’s getting what and why I’m not getting it too.

    • Woodchuck Pirate on February 2, 2017 at 09:38


      The mixed economy model is socialism not capitalism. “Even Republicans” are not stupid they’re by definition socialists, and by marketing definitions are differentiated as second string Democrats.

      “You may as well eat the devil himself as to sip his broth.” – Woodchuck Pirate’s Grandma

      Woodchuck Pirate
      aka Raymond J Raupers Jr USA

  4. Jim on January 29, 2017 at 20:11

    I think making pricing information transparent is important.
    I had an older relative visiting from a foreign country. His medical insurance from that country did not cover him in the US.

    He developed a painful kidney stone. We brought him to the ER, and they wanted to send him to the OR for a minor surgery.

    Because he had no coverage in the US, we asked how much the procedure would cost. Everyone at the hospital just looked at us, and no one could give us a price, or even an estimate. I even asked for a ballpark estimate: $1k, $10k, $100k? And no one could give us an answer.

    It was a very odd experience.

    • Woodchuck Pirate on February 2, 2017 at 10:03


      My daughter was born with cerebral palsy. She is 33 years old now and walks with a Kaye brand walker. When she was a kid I bought replacement walkers often. I remember once our insurance company wrote me explaining they overpaid their contract portion of the bill stating customary and reasonable charges verbage etc. They requested that I refund an amount immediately to the address instructed. I wrote back stating this was interesting but of course I will require detailed disclosure of the documentation defining customary and reasonable pricing so I could verify that their actual payment was indeed outside our contract. I explained that otherwise without such disclosure I had to assume that they were in error to request such a refund, and added that I had no way to determine when, where and how often they found themselves in error. I also added that I’ve never received a check for them in the past stating they were in error and didn’t pay enough, so perhaps they owe me a refund? I sent the reply certified mail and never heard another word from them about it. I really was looking forward to seeing those “pricings”.

      I’ve learned enough about the criminal medical monopoly to know that their entire industry is in violation of US anti-monopolistic law. Rand Paul and every politician (now includes Trump) is committed to maintaining the criminal medical monopoly practices and default into an economic downslide into WWIII. Nothing will survive of the USA after this last kick of the can on Trump’s tour of his swamp. Know your enemy.

      Woodchuck Pirate
      aka Raymond J Raupers Jr USA

  5. Ken on February 1, 2017 at 17:54

    Something I stumbled upon while I was researching where to get IV vitamin therapy (they may or may not do that, but the article was awesome):

    From another blog post… “bias is literally everywhere”

    Yes it is.

    The real meat of that article is the statistics showing what percent of people on public health boards that literally decide what your doctor should or should not tell you at an office visit… what percent of those people have vested interests in drug companies, or make money from sales of devices they review… etc. And the extent to which doctors have been prosecuted (not even by the un/satisfied patients… by the insurance co) and fined or lost their license for stepping beyond the Clinical Policy Guidelines (multiple such “panels of experts” exist, all publishing gag orders).

    If ever there was a time to ditch this system, it’s now.

    • Woodchuck Pirate on February 2, 2017 at 09:43


      The global economy is a balance sheet. Know your enemy. The solution is found at the individual level. Collective action is not the crowning achievement of the human race, rather it is the psychosis that will destroy it.

      Woodchuck Pirate
      aka Raymond J Raupers Jr USA

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