A thought on cash practice.

In the beginning it was not difficult. There was no insurance in 1967 everyone had a cash practice. I believe the average fee was four dollars when I began in practice. I began a box on the wall fee system, after all how much less than four bucks could someone drop in the box. The box system worked well and made so much sense to me that I kept it, even when average fees went up and insurance came into popularity. I kept it because I like it but that is not the thrust of this essay. This is about cash practice regardless of how you practice it. When insurance became popular many box on the wall practitioners changed over. I had a friend who did so and told me he was now making twice as much money and working half as hard with insurance, meaning his motivation was money in seeing as many people as possible. He had a different motivation than I did. (He died unexpectedly shortly thereafter even though he was younger than me and never got to enjoy that increased income that he was making.)

This article is not about box on wall practice. It is about the idea of a cash practice as opposed to insurance practice and one particular thought on that contrast. Ponzi schemes, we all know how they have worked out. The biggest Ponzi scheme has been the Social Security system began by FDR who was probably Bernie made off’s hero. The idea was that those who put into the system would see a return by those coming after them. Sounded good and most people jumped into the system. I forget the name of the first lady to get in but she paid in next to nothing and got a great return by living a good long time. We now know the problem with the system and how some candidates for president see a solution, others want to keep “kicking the can down the road.” Others don’t want to even talk about it. This article is not even about Social Security. It’s about the idea of insurance and the inherent wrongness of it. As a chiropractor I always felt that being lumped in with non-chiropractic people who would more than likely be using their insurance more frequently than me was somehow unfair inasmuch as I, with my premiums was helping to pay for their care especially when it came to the use or overuse of drugs. Somehow prospects of “insurance equality” made it acceptable. I guess that’s how all insurance and now  government entitlement programs are rationalized. They say we are all entitled to life, liberty, and not just the pursuit of happiness but the guarantee of it. Even though some people might never use chiropractic care, because it is not wanted, they have to pay for it for the people who are smart enough to choose it. Is that fair? I don’t know what the answer is. I know it’s not forcibly taking it from the haves and giving it to the have-nots is not the answer or taking from the don’t wants and giving it to the wants but are not willing to pay for is the answer. As a politician recently said “no one wants to see people dying on the streets” but surely there is a better way of solving the problem than in getting the government or the insurance companies involved. That’s what the cash practice is all about. Getting those who have been totally inept (the government)  out of the business of health and well-being and those who are in it for the money (insurance providers). The details and the system needs to be left up to someone smart enough,  smarter than me. That’s where cash practice comes in and for me a box on the wall was one way of solving that problem.