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.
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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