Here is a typical case; we see this 50 times each day. Let's look at how it normally works: The patient comes in; we do 21 lab tests on her. In a conventional model she has insurance, so we would bill the insurance. The lab then bills the insurance for $1,200. The insurer pays $800 and bills her for $400. She is thinking, good thing I have insurance, otherwise I would have paid $1,200. But the fact is we could have gotten the labwork for just $285.

We see a lot of heart scans, which are ultrafast CT scans to detect early heart disease. The imaging center will charge the insurance company about $2,500. The insurance company will usually pay about $2,000 and bill the patient $500. But we negotiated it down to $300 for cash.


There is so much waste in insurance where doctors just overbill and then the insurance company denies it and it goes back and forth.

DM: I am sure that many of your patients require medication as well.

KH: Often we'll have a medication that is needed and life changing but insurance won't cover it. So you appeal. And they ask, please send over every medication the patient was on for the last seven years with doses and why they stopped them. It goes back and forth and round and round. They think this is the medical history for the patient but how do they know?

The doctor may say it is life changing and the insurance company will say it doesn't matter, it's not medically necessary according to our criteria. Often if a patient is on a particular [costly] medication it may keep them out of the hospital and not use other medications but [the insurance company] doesn't see that.

DM: How do your patients pay for their drugs?

KH: Many are covered by insurance for medication, but we usually will find a cheaper drug that we negotiate down or we have a couple of pharmacies that will take less for cash. That is something the government could negotiate. It is ridiculous to get them cheaper in Canada.

DM: Your approach seems in keeping with preventive care.

KH: Patients are much more empowered, educated and involved with their care because they can decide with their health care dollars what they want to spend.

DM: Do you think your approach is only good for your specialty since endocrinology in particular requires an understanding of the whole patient? Or does it apply more broadly?

KH: I think if you want to solve the health care crisis, all you need to do is have all routine care on a cash basis. Every doctor, every hospital, every lab, has to post their rates and cash has to be the cheapest. Then, however you fund it, it will be about one-third of the cost of doing insurance billing or single-payer billing. Doctors will take much much less. Patients would just need an inexpensive catastrophic plan.

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