Bartering and whether doctors should be paid with chickens

Generally, I find my practice works best when I get paid in dollars. They’re convenient. They can be transmitted electronically between bank accounts. Mary and Annie like them. I can spend them by swiping a credit card.

But, in a remarkable effort to win the “Let’s See How Stupid I Can Sound” award, a Nevada candidate for U.S. Senate has proposed ditching the idea of paying doctors in money, and going to a barter system with them. Specifically, she suggested paying us in chickens or house painting.

Really.

Sue Lowden is the gem who hatched this idea. In fact, she was given a chance to explain it, on the assumption that she misspoke. But nope. When given the opportunity to clarify her point, she again clearly stated that medical services should be reimbursed by bartering goods, such as chickens, and not by paying money. She specifically indicated it was to pay doctors, and didn’t say if it should be applied to other business (such as buying your drugs at the pharmacy, or groceries at the store). She even said she wasn’t going to back down from the idea.

Barter is not a bad thing. In some situations it works. Most civilizations used it before the advent of money. But the majority of human cultures eventually developed cash of some form. Because let’s face it: it’s hard to carry around enough chickens to buy a car. And they’re messy. And, unlike coins, they require feeding.

This idea may work for some docs, but not me. I personally don’t want to collect co-pays in chickens. Or goats. Or frying pans. Or anything other than money. This is also a matter of cleanliness: my migraine patients are sensitive to smells. I don’t think they want to sit in a lobby filled with the livestock someone else brought to settle their bill.

And I don’t have enough space in my yard to handle all those co-pays. Mary and Annie are also not going to be thrilled to be told that instead of money I’m now going to pay them in sheep and legumes. It’s a baaaaaaaahhhhhhhhhd idea.

The logistics of making an ER co-pay become especially daunting, especially if you’re now in a wheelchair and but need to use the space in your car for bushels of corn and some turpentine.

And just try giving your kids a handful of chickens to spend at Chuck-E-Cheese’s.

We will also need to re-do medical school curriculum, to include care and feeding of livestock, as well as how to run your own slaughterhouse (for us non-surgeons) when turning your co-pays into dinner.

Ms. Lowden, to verify the usefulness of your idea,why don’t you try a simple experiment — go into any large casino in Las Vegas. With a chicken. And try to bet it on any game. Or stuff it in a slot machine. And then see what casino security thinks about being paid in something other than money. I suspect they’ll be as fond of the idea as I am.

Doctor Grumpy is a neurologist who blogs at Doctor Grumpy in the House.

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  • anonymous

    Two words: city slicker.

    Assuming for one wild and crazy moment that anyone would even want to be paid in chickens, most communities have ordinances prohibiting livestock within the city limits. There’s also the spread of Newcastle disease to think about.

    A chicken that has been appropriately butchered and plucked would be a slightly different story, of course. But there’s still a limit to how many chicken carcasses one can accumulate and eat in his or her lifetime. Perhaps the desert sun has affected Ms. Lowden’s brain.

  • http://www.bryantsstatisticalconsulting.com Tex Bryant

    Yet again we get to hear the sound advice of politicians, this one being from Nevada, Senator Reid’s home state. Ed Rollins on CNN.com states that Senator Reid is currently running behind his Republican opponents for the seat. Just goes to show how ridiculous ideas sometimes get the most attention and votes. Who ever thought that politics was sane all of the time? As Lincoln stated, you can fool some of the people some of the time.

  • 250joules

    Bartering with chickens- not so much.

    Used a better plan-ski lift passes at Whistler for exchange of services- which something I can use and not have to clean up after the chickens. This is something even vegans and the SPCA would be happy with.

  • http://blog.neurokc.com/?Tag=Healthcare Aaron Seacat

    Would these patients be required to have some proof of “livestock-malpractice” insurance? Our practice couldn’t take the risk of receiving chickens that may have contracted a disease during transportation to our clinic.
    And maybe Ms Lowden should propose that government establish an FDIC equivalent for agriculture – should the bottom fall out of the chicken market to protect our new currency.

  • jsmith

    A little econ 101 would help here. Google “double coincidence of wants” to learn why money is more efficient than barter.

  • Pratik

    Given that many American doctors are vegetarian Hindus, Buddhists, and Jains, there may have to use something else than livestock to barter with.

  • Diora

    How do you report chickens to IRS?

    • ninguem

      Chickensh!t comes to mind.

  • http://thehappyhospitalist.blogspot.com Happy Hospitalist

    Here’s an idea. The patient can sell the chicken for cash and then give the doctor the cash. That is, unless they decided that cable TV was more important

    Diora. Line 47 on your 1040 has it’s own itemized chicken tax formula.

  • gerridoc

    I used to care for a patient who owned a wine importing business. Bartering with her sounds like a good idea.

    • ninguem

      Same thing, only it was fisherman in a good-sized fishing port.

      One guy really did pay in fish. After a while, I owed him medical care.

  • http://turnyourheadandcoughMD.blogspot.com Max Power

    My preferred form of payment aside, where are the poor people supposed to get chickens?? Receiving treatment in exchange for goods (i.e. bartering) was common at times when a significant portion of the population were farmers. Cash in any form was scarce and so people paid for services in kind.

    That being said, I am willing to make deals with patients who cannot afford treatment but are willing to make an effort.

    I heard about a surgeon who would treat poor patients but require them to pay $200. Not because he needed the money, but because he felt that the patient needed to to associate some dollar value with their care. By paying the $200 the patient was making an investment into their own health, and thus tended to be more inclined to correct any unhealthy lifestyle elements.

    • ninguem

      Indeed. If it’s free it has no value.

  • Jack

    Perhaps she was trying to make a point… that greed has gotten out-of-hand in medicine and things need to change. Just a thought.

  • joe

    Jack:
    Greed? More like practice survival.
    There has not been a significant raise in medicare rates since 1997 (the year of the SGR). Tell me how much have your expenses gone up since 1997? Doctor’s are not immune to inflation, even if congress mandates are. Think my employees, the bank, or utilities will take the chickens? Of course not. I really do wish some people who comment on this forum were informed to the issues in medicine today instead of making blanket assumptions based on ignorance.

  • Jules Enatsky

    As a healthcare consultant who travels 100% to a different state and city each week I’ve seen a variety of co-pay methods. In some locations which are under served patients typically pay with bartered goods or services. I know of a Philippian doctor who lives and works in the Appalachian Mountains and accepts livestock from his patients as payment. As long as you base the goods on the fair market value of the item or service you can claim it as payment.
    This method certainly gives the provider the ability to collect for services rendered but just no in cash.

  • Molly Ciliberti, RN

    If Ms. Lowden gets elected, let’s pay her with chickens. We might throw in a dozen eggs just to mix it up a bit.

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