Voices

Robert's rules

Innovative doctor's practice of transparent pricing looks better than ever

Issue: "Hope or hype?," Jan. 20, 2007

Now and then, we end up with egg on our journalistic face. We feature some person or organization in WORLD-and then later have to admit that that person or that organization had feet of clay and didn't deserve the attention we gave them.

Naturally, I like it better when we can say, "I told you so." I much prefer watching someone to whom we devote editorial attention then go on to get even more coverage on an even bigger platform.

Twice in the last few years, we've told you about an unusual medical doctor, Robert Berry, who is trying almost single-handedly to revolutionize the way in which health care is typically delivered here in the United States. If I tell you, among other things, that Dr. Berry doesn't accept any payment from insurance companies, you'll get a sense of just how out-of-step he is. His PATMOS clinic (that stands for "Payment At TiMe Of Service") in Greeneville, Tenn., features signs in the patient waiting area that list the cash prices for a variety of treatments and services. Dr. Berry likes to point out that a typical bill is roughly equivalent to what a patient would pay for a lube or brake job on his or her car. His rates tend to be about one-third to one-half what patients would pay if they were using typical health insurance programs.

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PATMOS also refers-not so subtly-to the fact that Dr. Berry had to go into virtual exile from the medical establishment to do what he's doing. And although his clinic is now six years old, boasts a roster of some 7,000 patients, and provides the Berry family with an income that he says is roughly equivalent to what primary-care doctors earn in the United States-in spite of all that, he's still something of an outcast to the health-care establishment.

In other words, the Berry experiment is working with the people who need it most-the uninsured or barely insured consumers of health care. But it isn't working yet with the high priests of the bloated industry, who have way too much at stake in preserving the system that keeps them so well fed.

I revisit the bold Berry venture again this week after reading his address to a Washington dinner gathering of Consumers for Health Care Choices, a national organization that named Dr. Berry its 2006 "Pioneer in Medical Practice." At the dinner, Dr. Berry asserted bluntly: "If a physician accepts payment from a third party-be it a commercial insurer, the government, or an employer-he necessarily works for the payer. After all, 'He who pays the piper calls the tune.' Over the last few decades, the medical profession has become a finely tuned instrument in the hands of third-party payers. Two's company, but three's a crowd. It is time to remove these intruders from transactions involving everyday health care. Doing so will help restore the doctor-patient relationship."

Consumers should be prepared, of course, for a very different answer to the "three's-a-crowd" dilemma. The new Democratic leadership in Congress will be all too ready in the months just ahead to let Uncle Sam become the single payer for all the nation's health bills.

But in such a process, Dr. Berry points out, consumers will lose all track and all sense of what health care should really be costing. In his own town, Dr. Berry has challenged the local hospital to publish the prices of "routine, oupatient services available to physicians and their patients so that together we can plan cost-effective diagnostic strategies and treatment options." But the hospital refuses, saying it does "not want to release lists that are subject to misinterpretation."

Hiding or obscuring the true cost of any product or service is an almost sure sign the consumer is being ripped off. And if that practice is already rampant with private insurers in charge, it will only get worse when Uncle Sam becomes the ultimate payer.

That's why consumers of health care are better off when they insist on a one-on-one business relationship with their doctors and other medical vendors. And it's why we're happy not only to say we were right in 2002 to feature Dr. Robert Berry as a hero of the common citizen-but to predict that we may show up a few months or years from now with still another tribute to his forward-looking service.

Joel Belz
Joel Belz

Joel, WORLD's founder, writes a regular column for the magazine and contributes commentaries for The World and Everything in It. He is also the author of Consider These Things.

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