Doctors Who Hate Insurance So Much They Go Without It Themselves

(Bloomberg) -- As an E.R. doctor in New Orleans, Brian Falkner attends to the kind of gruesome medical cases that would seem to underscore the importance of health insurance.

And yet he doesn’t have any. Nor, for that matter, do his wife or 9-year-old daughter. After they lost their Affordable Care Act plan last year, Falkner decided to just go without. He’s happy -- so far -- with the results. Their spending on doctor’s appointments and prescriptions has come in well under the $1,200 they were shelling out in monthly premiums.

“It’s actually better,” said Falkner, 40. That is in no small part due to good luck. No one in the family has encountered any health crises this year, but even the possibility of catastrophe doesn’t give the doctor pause.

Falkner was one of more than 4,000 Americans who responded to a Bloomberg News questionnaire on living without insurance, and among the surprises: health-care professionals who willingly go without coverage. Nobody knows better how financially devastating a heart attack or even a busted leg can be if you’re going it alone, but that’s how fed up these doctors and nurses are with what they view as a broken model.

“You would think that these are educated folks who understand they’re limited in their ability to predict what kind of health events might happen to them down the road,” said Sabrina Corlette, research professor at the Georgetown University Health Policy Institute. “On the other hand, there’s certainly a tipping point when premiums keep rising.”

For more: Desperate or Reckless? These Americans Are Dumping Insurance

There are no reliable data on how many in the profession are uninsured. Their income alone would seem to make them outliers. The lowest-paid doctors -- pediatricians and physicians in public-health and preventative medicine -- typically earn around $200,000 a year, according to Medscape. A registered nurse makes an average of $80,000 annually.

Some health-care workers make much less and simply can’t afford coverage. Premiums can be a challenge for those who are well compensated but are independent contractors and not always eligible for employer-sponsored plans, which is the case with many emergency-room doctors.

But for Brad Why, a psychiatric nurse practitioner in Hockessin, Delaware, cost wasn’t the main issue. He canceled his family’s plan this year after developing a “pretty significant disrespect” for insurance companies.

They’re “dictating who is getting what, how much they’re getting, putting limits on the care that you receive and the medication that can be prescribed,” said Why, 49. “I just don’t want to pay them anymore.”

Why found providers will often negotiate with uninsured patients and that appointments can cost less than his co-pays. He saves the $1,800 he used to pay in monthly premiums. His old plan carried a $13,000 deductible anyway.

Rolling Dice

Anyone who goes without at least catastrophic coverage, of course, is “rolling the dice,” said Robert Berenson, an internist and a fellow at the Urban Institute in Washington. True, medical professionals are informed consumers when it comes to health care. “They know enough to get by,” Berenson said. But “they can get hit by a car, they can get cancer, and no amount of knowledge is going to protect them if that happens.”

Nemat Dadfar, an emergency physician in San Antonio, said he gets it. If he has a heart attack, he knows “it wouldn’t be cheap.” The 39-year-old abandoned his personal policy after becoming frustrated with billing paperwork and haggling over reimbursements at work. “I just want to be able to do my job, and do it well, and take care of patients. What I’ve found is that the system is designed to prevent you from doing it.” He didn’t want to have any part of it as a patient.

That’s a common thread. “Employed physicians are now equivalent to high-paid data entry clerks with all of the bureaucratic inefficiencies,” said Landon Roussel, who left a hospital job a year ago. Now he has a direct primary care practice in Baton Rouge and Lutcher, Louisiana, that doesn’t accept insurance; patients pay an average $50 a month for unlimited visits. He himself belongs to what’s called a Christian health-sharing ministry, in which members pay monthly fees into a pool that helps pay for everyone’s bills.

Falkner has no net, and said he’s comfortable with his decision not to re-enroll in an ACA plan after being dropped due to glitches in the automatic-payment setup. There are “ways to navigate it and make payments intelligently,” he said. “I’m not quite winging it when I’m going without coverage.”

©2018 Bloomberg L.P.

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