Editore"s Note
Tilting at Windmills

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April 12, 2010

'BARTER WITH YOUR DOCTOR'.... Once in a great while, we get a peek at Republicans' health care ideals, but rarely do we see them articulated as candidly as Sue Lowden described them last week.

Lowden is a former state senator and chair of the Nevada Republican Party. She's also, according to nearly every recent poll, the favorite to defeat Senate Majority Leader Harry Reid (D) in November. Lowden is not, as one might imagine, a supporter of recent improvements to the broken health care system, and she was asked at a candidate forum the kind of policies she'd prefer to see. Among her proposals:

"...I would have suggested, and I think that bartering is really good. Those doctors who you pay cash, you can barter, and that would get prices down in a hurry. And I would say go out, go ahead out and pay cash for whatever your medical needs are, and go ahead and barter with your doctor."

Think about how this would work outside the realm of campaign rhetoric, and apply it to real-life. Someone feels ill and makes an appointment to see a doctor. The patient is concerned about her health -- maybe the ailment is serious -- and is feeling sick. The physician evaluates her condition and recommends some medication and tests.

At this point, in Lowden's vision, the ailing patient should turn to the medical professional and say, "Well, you know, that medication will probably cost about $200. Tell you what; how about I give you $130 and we call it even? And those tests you think I need sound kind of expensive. I may have a life-threatening illness, and I'm feeling weak and vulnerable, but I'm also looking for the best possible bargain. What kind of deal can you give me on that CT scan? And do I really need that blood work done?"

I also enjoyed hearing the would-be senator encourage people to "pay cash for whatever your medical needs are." Since Republicans tend to think Americans already have too much health insurance, Lowden's advice fits nicely into the larger GOP worldview.

Remember, Lowden has had plenty of time to craft her message on health care policy, and this is what she's come up with.

It seems hard to imagine voters finding this compelling, but it's an odd year.

Update: Some readers have suggested that I've confused "bartering" with "bargaining." Actually, I think Lowden has them confused. Unless the Republican candidate actually imagines a scenario in which sick people trade unrelated products and services for medical care, she probably was proposing some kind of haggling scenario.

Steve Benen 1:50 PM Permalink | Trackbacks | Comments (91)

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Perhaps she meant "bargain", but what she was saying was "barter."

As in, "Hey, I own a landscaping service. How about instead of paying you $1000 for that outpatient surgery, I send a crew to your house and do $1000 worth of work on your yard?"

Posted by: emrventures on April 12, 2010 at 1:47 PM | PERMALINK

No, no, no. You're confusing bartering with haggling. When the doctor tells you that you need an operation, Lowden wants you to ask him how many pigs he would like in return, or how many times you will need to mow his lawn to pay him back.

Posted by: Tim H on April 12, 2010 at 1:48 PM | PERMALINK

She's not talking about just lowering the price, but
bartering, as in trading goods for services.

I don't see how that would lower the price, since you'd still have to give up something.

Come tax time, I don't think the doctor would claim the full value of, say, a gift-in-kind.

Hit her hard on this one, Harry!

Posted by: Tom Nicholson on April 12, 2010 at 1:48 PM | PERMALINK

What would the pro-lifers suggest be done with a neonate born eight weeks early when the parents offer the hospital $2000?

Posted by: reino on April 12, 2010 at 1:48 PM | PERMALINK

The US is in reality a third world country, with a small oligarchy running everything, having successfully managed the little trick of making the middle class think it's rich.

Barter with my doctor? Let's see, wonder if he's interested in my CD-collection?

Posted by: SteinL on April 12, 2010 at 1:49 PM | PERMALINK
"And do I really need that blood work done?"

As someone who needs frequent blood-work done, which often runs almost a thousand dollars every three months, this is assinine. The labs determine what they charge for each test, not the doctors. Same for other examples in this post. Very few private doctors have a CT scan machine in their office and have to out-source the diagnostics. The doctors don't set the fee, but the companies they use do. Same with x-rays, etc.

Posted by: Michael W on April 12, 2010 at 1:49 PM | PERMALINK

Hey, I know the thing people like MOST about buying a car is haggling over the price. People just ~love~ the charade of the salesperson going back to talk to the sales manager, gaining you a grudging concession to remove the undercoating. Just think of how much more fun it'd be if you were hacking up a lung and your life was in the balance! Good times!

Posted by: Mike D on April 12, 2010 at 1:49 PM | PERMALINK

There certainly is a role for negotiations (I don't think "barter" is the right word--it would be bartering if the patient offered to trade a pig for medicine), but I don't think it makes sense for it to be done by individual patients. It's the role for insurance companies and/or the government. You need a buyer with clout in order to have any hope of forcing down prices.

Posted by: Daryl McCullough on April 12, 2010 at 1:50 PM | PERMALINK

"It seems hard to imagine voters finding this compelling, but it's an odd year"

I don't think people will find that compelling, but I do think voters will. there's a big difference there. I suspect the turnout in November will be light. My fear is that we'll see some pretty dramatic results (and pretty tragic ones...like this lunatic gaining office) courtesy the handful who voted.

The Democrats need to get the vote out, plain and simple. If they can't, then a fringe minority will be setting the nation's agenda.

Posted by: SaintZak on April 12, 2010 at 1:50 PM | PERMALINK

Uh... This is the most illogical proposal I have heard since House Bill No. 246 was debated by Indiana State Legislature, in 1897, tried to set the value of pi so it was a rational number.

Posted by: KurtRex1453 on April 12, 2010 at 1:50 PM | PERMALINK

Actually, to "barter" is "The act of trading goods and services without the use of money."

Sounds like she's not proposing going to paying cash, but goods and services. What, exactly, we don't know - the old stories of paying your doctor in live chickens are probably out of date in all but the most rural areas of Nevada.

On the other hand, it might be applicable in these times. If I need medicine, perhaps I could trade my Wii, or my TV, car, etc. Or I could do house or yard work.

Of course, we are talking about Nevada here, so more imaginative goods and, more to the point, services might be applied to this barter system. And you doctor knows what health issues you might have as well as your overall physical condition, so he or she has unique assurances as to the quality of said services.

Posted by: The DeMBA on April 12, 2010 at 1:51 PM | PERMALINK

US doctors are sharks. They'd cut you open, pull you out of anaesthesia and suggest that terms be renegotiated before they continue.

Posted by: SteinL on April 12, 2010 at 1:51 PM | PERMALINK

I gave my doctor some beads and animal hides and he knocked a Franklin off my bill.

Posted by: doubtful on April 12, 2010 at 1:54 PM | PERMALINK

This is the most inane naive proposal since that cadaverous Nancy Reagan's "Just Say No".

Posted by: buddym on April 12, 2010 at 1:56 PM | PERMALINK


Two patients enter, one patient leaves.

\no comment by Tina Turner

Posted by: terraformer on April 12, 2010 at 1:56 PM | PERMALINK

Barter with your Doctor- sounds like an internet porn site. . .

Posted by: DAY on April 12, 2010 at 1:58 PM | PERMALINK

And just when on the MDs four-an-hour patient schedule is he going to pencil you in for a price negotiating session?

Posted by: Virginia on April 12, 2010 at 1:58 PM | PERMALINK

"Hi, I may be woozy from lack of blood due to this car accident I just had, but before I black out I'd like to barter with you ambulance attendants! I don't have much but I've been known to give a nice foot rub, so how about it? Two foot rubs for a ride to the hospital and some pain killers! Throw in a gurney, and I'll add a calf rub with some herbal oils! Howabout it?"

Oh yeah, that'd work.

Posted by: Gummo on April 12, 2010 at 1:59 PM | PERMALINK

Barter or bargain, we can't count on the Repubs to be exact in their language.

Nonetheless, this is the advice given and the support for one of the Repubs favorite Health System cures, Health Insurance Savings Accounts. Let YOU choose where your money goes and it will drive down the cost of medicine. Obviously, for all the reasons given it will only work on the margins (it's great when you are young and healthy, as long as you actually don't ned it). But damn, the Repubs really think it's the greatest thing in healthcare since tort reform.

Posted by: martin on April 12, 2010 at 2:00 PM | PERMALINK

If I were Ried I would grab the video of this idiot saying this and run TV ads with it featured.

Camera opens with Sue Lowden speaking:

"...I would have suggested, and I think that bartering is really good. Those doctors who you pay cash, you can barter, and that would get prices down in a hurry. And I would say go out, go ahead out and pay cash for whatever your medical needs are, and go ahead and barter with your doctor."

Ried 's face fades in: "I guess Sue would run the Senate the same way. She's tell the Russians that she'd give them some corn if they got rid of their nukes; or Kim Jong Ill that if he'd deep six his nukes, she'd send him some cash or maybe some Chevys. Lots of em. Sounds interesting Sue. Keep talking..."

Posted by: Stevio on April 12, 2010 at 2:01 PM | PERMALINK

At least it's not socialism.

Posted by: mister moonlight on April 12, 2010 at 2:02 PM | PERMALINK

Americans must have the attention span of gerbils if we elect these incompetant nitwits to run the country. For fucks sake can't we remaember the sheer incompetant nimrods that were in charge the last time the repubs were in power.

Posted by: Gandalf` on April 12, 2010 at 2:03 PM | PERMALINK

I think it appropriate at the next news conference (or debate) to ask Ms. Lowden (a) when was the last time she negotiated with her doctor along the lines she suggested and (b) how'd that bartery-haggly thing work out?

Posted by: artsmith on April 12, 2010 at 2:07 PM | PERMALINK

Bartering? WTF?

This woman is simultaneously stupid enough to suggest bartering as a solution to the healthcare crisis and too stupid to know the definition of bartering vs. bargaining or haggling.

What a vapid, idiotic woman. If the people in Nevada elect this twit to represent them in the Senate, they'll be getting what they deserve.

In two years they'll have an unregulated nuclear waste dump and a corporately owned prison system all employing non-union workers at slave wages and safety records to match Massey, Inc.

Posted by: Winkandanod on April 12, 2010 at 2:10 PM | PERMALINK

This is just more GOP nostalgia for bygone days of yore. You know, back when a country doctor might accept a couple of chickens or a suckling pig as payment for a house call. I know that it's true, 'cuz I saw it on an epsisode of Gunsmoke!

Posted by: AK Liberal on April 12, 2010 at 2:15 PM | PERMALINK

She thinks everyone should put $20,000 a year in their pre-tax health savings account. That should work for about .5% of the US population, but still not be near enough to cover catastrophic costs.

Posted by: cr on April 12, 2010 at 2:15 PM | PERMALINK

Has Lowden visited a doctor's office lately? Here's what happens: The receptionist says, "Can I have your insurance information?" You give her your card, or you tell her you're paying out of pocket. In either case you then sign a form saying that you'll be responsible for the charges, whether or not your insurance covers the visit or you can afford it out of pocket.

So I'm having a hard time seeing how Lowden says, "I'd like to see the doctor before I sign this form, so we can work out a deal about how much I'll pay." Because the natural answer to the question of "Will you take less?" is "No." It's not as if there's a glut of struggling GPs on the doctor market.

Posted by: RSA on April 12, 2010 at 2:18 PM | PERMALINK

Maybe she can team up with Meg Whitman, so we can all can bid for medical services on eBay!

And what is this thing called "cash" people are supposed to pay with? Does she no know that most folks have pretty much emptied out their mattresses by now?

Posted by: gradysu on April 12, 2010 at 2:19 PM | PERMALINK

"Hey doc, give me a heart replacement and if I survive I'll repaint your garage every year for the next 180 years" ????

Actually, I'm fine with this as long as we get to pay Lowden's next governmental salary in horse manure. Quality manure can cost $10 per ton or so, and I suspect the public would even be willing to thank her for her work by throwing in an extra ten or twenty percent.

Posted by: N.Wells on April 12, 2010 at 2:20 PM | PERMALINK

Jebus, almost thought there's no real 'muricans on this site, but AK Liberal @ 2:15 finally showed a bit of sense.

Posted by: eserwe on April 12, 2010 at 2:21 PM | PERMALINK

I was going to add a suitably pithy comment, but I made the mistake of reading all the preceding comments first. By the time I got down to the magic window at the bottom, I was so helpless with laughter that I could no more type than tapdance. That's some funny shit up there! If I were a Republican (impossible, because my body wouldn't tolerate the shutdown of so many vital systems), I would blush from humiliation at being so thoroughly filleted by so many excellent wits. Standup comedy gold stars go out to Tim H, Mike D (dark, but brilliant), doubtful, terraformer and Gummo (I almost ran last night's hot dinner through my pants). Please get together and form a panel that could be flown around the country to Republican debates, solely for the purpose of mocking them into apoplectic fury.

Posted by: Mark on April 12, 2010 at 2:21 PM | PERMALINK

This is beyond stupid. The fact is, no one seems to really know what some things will cost.

Recently my husband had surgery. We have junk insurance, so in an attempt to save money where we could I asked for an estimate of the cost. The doc's office was rather stunned by the question. Apparently they don't get asked very often. It took a week and what I got was a very rough idea of the hospital and surgeon's charge. I will be curious how close it was after all is sorted out. Perhaps I will offer to barter cookies or motorcycle repairs in our shop.

Posted by: Haplogroup V on April 12, 2010 at 2:22 PM | PERMALINK

She in a weird explained why free market forces don't work with health care. If I'm having a heart attack I'm not going to worry about the "value" of my upcoming heart surgery, I'm gonna agree to pay whatever the ask for, since I'm not exactly in a bargaining position.

Posted by: Archon on April 12, 2010 at 2:24 PM | PERMALINK

BARTER with a doctor? How do you think the average Ob-gyn is going to respond to that?

This is fucking idiotic. What got-damned planet does this Lowder woman live on?

Posted by: kc on April 12, 2010 at 2:29 PM | PERMALINK

I guess Lowden hasn't heard that most country doctors like to be paid in chickens.

Posted by: Death Panel Truck on April 12, 2010 at 2:29 PM | PERMALINK

What next, indentured servitude?

Posted by: Mudge on April 12, 2010 at 2:38 PM | PERMALINK

Right, and maybe they can list their services on Craig's List. Triple bypass, $10,000 and we'll throw in a couple pints of blood and an iPod.

Posted by: ScottW714 on April 12, 2010 at 2:38 PM | PERMALINK

LOL! Little House on the Prairie.

Posted by: Silver Owl on April 12, 2010 at 2:39 PM | PERMALINK

I like the part where she talked about how HSAs work great, you just need to get up to $20,000 in the account so that you can meet the catastrophic deductibles when something goes wrong. It was like she was outlining in real time why HSAs work great for someone at the income level of Sue Lowden, who spent years as upper management at various big hotels, but are completely worthless when you try to use them as a catch-all solution for our nation's health care problems. Sure, they're great. Assuming you can sock away $20,000

Posted by: mcc on April 12, 2010 at 2:40 PM | PERMALINK

This is fucking idiotic. What got-damned planet does this Lowder woman live on? - kc

Amen. Further, what planet do the people of Nevada live on that she's the front-runner?

Posted by: June on April 12, 2010 at 2:40 PM | PERMALINK

I kinda like the idea of actually bartering as opposed to bargaining. It's even more ridiculous.
"Okay, I'll give you two jars of my mom's strawberry preserves in exchange for that triple bypass. No? Okay, four jars, final offer. What? Well, fuck you too. Good luck finding something else to spread on your toast, JERK!"

Posted by: Allan Snyder on April 12, 2010 at 2:42 PM | PERMALINK

I could work for free in the ER as a scrub nurse or orderly, emptying bed pans in the ICU. How hard could that be? I watch ER and House on TV, so that is training enough.

Gosh, what a great idea! Just eliminate cash and go back to the old days when we shared everything...hmmm is that socialism or communism?

Posted by: st john on April 12, 2010 at 2:42 PM | PERMALINK

Doctors created the non profit Blue Cross and Blue Shield because they were tired of being paid in chickens. Then came employer provided insurance from private, for profit companies. The Blues wanted them some of those profit. The insurers made life miserable for doctors and patients. That's why the AMA supported HCR. I guess it must be time to rinse and repeat. Have some chickens, doc, or are you up for a dressed out hog today?

Posted by: art hackett on April 12, 2010 at 2:43 PM | PERMALINK

I suppose Sue will dress up like "Dr. Quinn, Medicine Woman" for her campaign spots?

Posted by: KTinOhio on April 12, 2010 at 2:44 PM | PERMALINK

Sue Lowden, another yahoo who started as a local Las Vegas newscaster.

Posted by: flyonthewall on April 12, 2010 at 2:45 PM | PERMALINK

I just called up my local hospital and tried to "barter" with them. My son had to go to the ER for intestinal pain (we feared appendicitis, it was not) and we were mailed a $2600 bill after insurance picked up their share.
Turns out, they wouldn't reduce what I owed, but said they would be happy to extend a one year payment plan at no interest. The "bartering" didn't exactly get prices down in a hurry.

Now, I know I probably should have tried to "barter" in the emergency room prior to the doctor seeing my son. But to be honest, my son's howls of pain threw me off my game and I forgot to haggle. I probably could have gotten the ER doc to authorize a good discount too, after he got on the phone to the finance department and left a message for them (since this was around midnight on a Saturday) and then waited for the call back on Monday morning. Although the doc probably wouldn't have heard me over my son's screams of pain anyway.

Posted by: Gridlock on April 12, 2010 at 2:45 PM | PERMALINK

This crap could obviously make for hilarious and effective campaign commercials and could be also useful in debates (which if they exist maybe 1% of the voters would see). And surely anyone who comes up with this kind of shit must have said all kinds of other stupid things. But...Harry Reid? I've never seen his campaigns in the past, but every time I see him I wonder how this guy who seems like a librarian or accountant or something ever got elected, particularly from a district that is no doubt well to his right. I mean, I'm sure he's a really decent and thoughtful person and I bet even I agree with him on a lot of stuff, but he's a little short in the easygoing good-ole-boy charm and humor department. Has he just run against non-Mormons in the past? Well, give 'em hell, Harry. If you can.

Posted by: emjayay on April 12, 2010 at 2:46 PM | PERMALINK

Questions for this clown:

1) what insurance do you have? what does it cover, and how much does it cover?

2) when did you last pay cash to your doctor?

3) when did you last *bargain* with your doctor? Please describe the experience in detail.

What a contemptible fool. Absolutely ridiculous fool. And if Nevada puts her in the Senate, they're greater fools.

Cripes. The only thing dumber than the average American voter, is the average GOP politician.

Posted by: LL on April 12, 2010 at 2:46 PM | PERMALINK

What next, indentured servitude?

Posted by: Mudge on April 12, 2010 at 2:38 PM

If the GOP had its way, yes!

Posted by: electrolite on April 12, 2010 at 2:49 PM | PERMALINK

Isn't the 2010 limit on HSA contributions $3050 for an individual and $6150 for a family?

Posted by: doubtful on April 12, 2010 at 2:50 PM | PERMALINK

As the grandson of an MD who DID barter for services, this suggestion hits me as all too 19th century. The last time bartering - or even negotiation - for medical services was at all practical was in the 1930s during the Depression when nobody had money for anything. My family ate very well, but were as cash-strapped as the rest of the populace.

Assuming "barter" is really what Lowden had in mind, what would she expect we barter for medical care? Few of us have skills that a physician would need, or value enough to trade. Bartering those would depress the value of those skills substantially. As for the rest, we have long since moved away from an agricultural economy. Once you get past groundskeeping, housekeeping, bookkeeping, transportation and equipment maintenance there's not much that would appear to be of value to a physician that remains in the US labor pool; and for those in unskilled occupations the consequence for anything beyond basic services could well be indenture, working off their bills as receptionists and other menial staff.

Also, with whom would we negotiate? Most GPs take your temperature and blood pressure and immediately refer you out to a lab for tests and a specialist for most procedures. Would we then have to make arrangements with the lab(s) and the specialist(s)? Never mind dealing with the prescriptions, which values would be set by the manufacturer and not the pharmacy and with which businesses negotiation is difficult even for the insurance providers and the government (who presumably have more clout than an individual patient).

Lowden's idea is a pretty fantasy for a frontier town with one or two doctors handling all their patients' needs and concocting their own medications. The US moved past that model long ago. Suggesting that the modern medical market could tolerate the practices she lists shows very clearly just how out of touch she is.

Posted by: boatboy_srq on April 12, 2010 at 2:51 PM | PERMALINK

Patients are, for the most part, not in a position to barter. Individuals have no leverage to speak of and some regulations (from government and private insurers) won't allow that to happen or the physician loses access to the patients and the patients may end up paying anyway. The insurance companies are in a position to bargain and, with the exception of the government run programs, they do it for their own bottom line.

In fact, Sue Lowden's remarks are a good argument for the existence of a patient owned entity to do the bargaining. Such entities like regional co-ops, government run programs, and non-profits (think the old Blue Cross) are more likely to have low administrative fees and more influence.

Medical care is not a free market situation. It is more like the three body problem in physics except in this case the three bodies are the patients, the medical establishment, and the money - insurance companies, self payers (who are usually companies) and government. None of these groups have completely overlapping needs and motivations and within each group there are tensions that move motivation and needs around. As a result there is little predictability and the side who games the best wins. In this case mostly the insurance companies who were unregulated compared to the medical establishment and could get away with recission, cherry picking, pre-exiting conditions, etc. These are not real insurance companies - insurance is a bet against a rare occurance taken by a lot of people and everyone gets sick so it is not a rare occurance - rather it was a situation under the old rules in which the insurance companies could pick and choose so they would not have to pay and they could refuse to pay for slight irregularities if they wished, which they mostly did. (To be fair, this applies mostly to individual policies which take up a large minority of those insured.)

But I am sure that this is too complex for some to absorb.

Posted by: mikeyes on April 12, 2010 at 2:56 PM | PERMALINK

Hey Doc? How 'bout you give me that experimental cancer treatment and I'll give you this flat screen t.v.? Its only a couple years old and works real good. No? How bout I throw in a microwave and my golf clubs? You docs like to golf don't you?

Posted by: The Fool on April 12, 2010 at 2:58 PM | PERMALINK

I once saw a picture in a book on the Great Depression of a dentist's office, with a sign that said something like "will work in exchange for produce or chickens."

I think Harry Reid should track that picture down and intersperse it with Sue Lowden's comments as the Republican plan on health care. I don't care if she meant bargain. She deserves to live with her words, and efforts to "correct" herself will only make her look more stupid, as most people realize the difficulties associated with "bargaining" with doctors for health care services. These people aren't serious.

Posted by: Barbara on April 12, 2010 at 2:58 PM | PERMALINK

Doc Spencer used to take chickens from his poor subsistence farming patients.

Posted by: Pentimenti on April 12, 2010 at 3:00 PM | PERMALINK

This is why Republican leadership refuses to offer a HCR plan -- they've got next to nothing, and what they do have is laughable.

Posted by: JWK on April 12, 2010 at 3:04 PM | PERMALINK

This is what I heard Rush Limbaugh advocating months ago as his ideal solution to the health care situation, and I think he said that it's what he does personally. All road lead back to talk radio.

Posted by: Steve V on April 12, 2010 at 3:05 PM | PERMALINK

There are so many amusing aspects to Ms. Lowden's suggestion, but (yet another) one is this: no one pays me anything for the medicines that I prescribe. I recommend a treatment, and they go to a pharmacist of their own choice to buy their medicine.

The fee they (or their insurance company) pay to see me is often a pittance compared to the cost of the medications.

Good luck trying to swap that chicken with Wal-Mart in exchange for filling your prescription.

Posted by: Dr. Davran on April 12, 2010 at 3:08 PM | PERMALINK

I've actually spoken to social conservatives, all with gold plated health plans, who think 'bartering' is a do-able maneuver.

They think you could offer to do the doctor's lawn, or walk his dog, or much out the garage or something.

Posted by: cld on April 12, 2010 at 3:20 PM | PERMALINK

I wonder how she pays her staff? Does she barter with them? "You show up for work and I'll cook you dinner Saturday night. Oh, not enough? Then I'll pack you a lunch Monday thru Wednesday." What are her assets and how are they valued in terms of bartering? Where does one store the bartered goods and account for the services? How does one calculate taxes on the bartered goods? Seems to me there was a movement a few years back to create bartering systems, but there was an issue with taxation.

Has anyone actually asked this person to clarify her statements? LL has some good questions.

I am truly encouraged by the blatant ignorance coming out of the opposition to human values and needs. This shows that fear is being exposed and those with compassion now have an opportunity to offer authentic solutions to the many challenges all of us face as a community.

I am committed to Oneness through Justice and Transformation.
st john

Posted by: st john on April 12, 2010 at 3:21 PM | PERMALINK

I meant they like to think you could offer to 'muck' out the garage, of course.

And it is only just that they like to think about themselves thinking that.

It's just the snickering level of contempt they have for anyone else's interest. The more serious the interest, the more contempt and snickering.

Posted by: cld on April 12, 2010 at 3:28 PM | PERMALINK

Just the other day, my friend's little boy sliced off the tip of his finger in a hand blender. She was SO ridiculous, though. She just picked up this screaming, bleeding toddler and rushed him to the nearest emergency room.

Obviously, what she should have done was send his sister to go look for the top half of his finger, while she called three or four emergency rooms to get the best price: "I've got St. Luke's on call waiting, and they're bidding $350. Can you beat that? Okay, will you match it and throw in a free hangnail removal for my husband?"

Clearly, this politician is a genius. Sick people haven't done nearly a good enough job haggling for lower prices--that's what's driving up costs! The biggest problem with hospitals is that they're not enough like a used car lot!

Not to mention, do these people have any idea what happens at a doctor's appointment? You have to be some kind of master negotiator to get naked in front of a person, lie down and let that person literally stick their fingers in your private parts & feel your breasts...and then go back into their office and drive a hard bargain. (not to mention, if there's anything in that office that I'm going to second-guess, it ain't whether the freaking blood test is absolutely necessary!)

More to the point, I'm supposed to trust this professional enough to let them put their finger up my ass, but not enough to believe they're charging me an honest price for it? Seriously?

Posted by: Anon on April 12, 2010 at 3:33 PM | PERMALINK

I look forward to offering Bristol-Myers-Squibb some fresh eggs from my backyard chickens in exchange for my heart meds. I'm sure they'll be interested, if we can get Lowden to talk to them.

Posted by: biggerbox on April 12, 2010 at 3:37 PM | PERMALINK

I worked as an intern architect for a registered architect who decided to participate in a professional bartering program - professionals serving each other with in-kind service. A dentist contacted my boss about trading dental work for architectural design services. He asked by boss what a customary fee for the design of a house was and then he was shocked when he did the calculation as explained by my boss. My boss looked at his number and said, "Actually, you need to add a zero."

Apparently, in this case anyway, one professional was so out of touch with what other professionals charge that he couldn't fathom the design of a house costing anymore than a couple of root canals. I can only imagine the would-be Senator's plan creating chaos at the doctor's office. But I think it illustartes that the average Republican politician is equally as uninformed about the real issues effecting average citizens.

Posted by: Vandal on April 12, 2010 at 3:41 PM | PERMALINK

I'm betting she really did mean bartering. A fondness for pre-cash economic exchange is oddly popular with goldbuggers, and the overlap between goldbuggers and teabaggers is pretty high.

Posted by: aretino on April 12, 2010 at 3:50 PM | PERMALINK

In 1949, my father accepted a television set in exchange for a hemorrhoidectomy. He offered to do it at no charge, but the patient insisted on giving him something. We had that TV until 1967. I think that would not happen nowadays.

Posted by: Soprano on April 12, 2010 at 3:55 PM | PERMALINK

It's all clear to me now... up until now, whenever I've seen some vagrant here in Michigan with a huge bag of empty pop cans, I've always assumed that he's just going to turn them in for the deposit at the local convenience store. Now I know that he's really collecting them to pay the surgeon to remove the burst appendix that's been bothering him.

Posted by: bluestatedon on April 12, 2010 at 3:57 PM | PERMALINK

My niece is a reconstructive surgeon. She did some work on the local Porsche dealer's wife, and the dealer must have been pleased, as he gave her a good deal on a Porsche. Is this the sort of thing Lowden was recommending?

Posted by: J. Frank Parnell on April 12, 2010 at 4:20 PM | PERMALINK

A self-employed friend of ours who just went through chemo and radiation therapy and is no uninsured is on a cash basis with her physician. She was just telling us just this weekend that her doctor did make a barter arrangement for her professional services last week. Of course, it sounded like he got the better of the deal, knocking off a portion of her bill for something she usually charges a couple of thousand dollars for, but then hey, she's got cancer, what's she going to do?

Posted by: darrelplant on April 12, 2010 at 4:27 PM | PERMALINK

What next, indentured servitude? - Mudge @ 14:38

If the GOP had its way, yes! - electrolite 14:49

Using the numerous examples above, it is clear the death panels would kick in when there isn't anything you can offer that would even approach a percentage of the bill. You're upside down, worthless. Be gone with ya.

And Allan Snyder @ 14:42, I can fix the equipment your Dr would use to fix your triple bypass, I'm totally interested in a jar of your moms preserves. To avoid the headache of determining worth, can we use the universal currency; cash?!

And to put this column into action, we should all ask our Walmarts and Bristol-Myers-Squibbs and [medical supplier] if they accept chickens while using the name Lowden freely. What a powerhouse she is.

Posted by: Kevin (not the famous one) on April 12, 2010 at 4:29 PM | PERMALINK

Well this should endear Republicans to the AMA. If the docs thought reduced Medicare compensation was bad, wait until every patient walking in the door wants to make a killer deal on their health care.

So now health care will actually cost you the shirt off your back.

And I'm sure the family values crowd will love the fact that patients will now be propositioning sex to their doctors in exchange for health care, if that's all they have left. What a wonderful world these Republicans are envisioning.

Posted by: petorado on April 12, 2010 at 4:43 PM | PERMALINK

This is just a new, creative way for the GOP to say, "Poor people ... you go screw yourselves." Substitute "barter" for "screw", and then you get the idea.

This isn't a real policy argument - it is just a bad-faith claim that is designed to occupy space, and give the GOP something to say that sounds vaguely macro-economic. Sort of like the GOP's prior claims that there is no real health care problem in the United States - just a failure of personal responsibility, plus too many greedy lawyers. And that health care isn't "unavailable" so long as you can go to an emergency room ...

How do you get away with something like this? Simple. If you press the GOP's candiates on the details - which the media will seldom do - they can claim that they are just raising issues and thinking outside the box, and that they favor creative, market-oriented ways to reduce costs and improve the quality of health care for patriotic, flag-waving real Americans.

So it is BS, followed by hand-waving. You get the picture.

Posted by: Bokonon on April 12, 2010 at 4:44 PM | PERMALINK

I wonder what would have happened if her husband, Paul Lowden, had attempted to barter with his partners at the Hacienda Hotel/Casino.

I believe their names were Frank "Lefty" Rosenthal and Joey Cusamano.

You could do a Google search for more research on those guys.

Posted by: Chomen on April 12, 2010 at 5:04 PM | PERMALINK

Is she married to Snuffy Smith?

Posted by: Wow on April 12, 2010 at 5:08 PM | PERMALINK

what can you say: republicans are detached morons.

Posted by: zoot on April 12, 2010 at 5:20 PM | PERMALINK

there was a doctor n Louisville Kentucky who was bartering Oxy scripts for oral sex. He's in jail now.
But seriously, how long would this last as an idea? Dr's have hundreds of patients, how many dozen eggs or sides-of-beef or concrete patio repairs would one office need on a regular basis? or should doctors have to put up signs describing the types of goods and services they are in the need of and then you'd choose your health care provider based on that... this is dim.

Posted by: andyvillager on April 12, 2010 at 5:50 PM | PERMALINK

That these drooling morons could actually win in November is like being run over by the Energizer Bunny.

"Nobody ever went broke underestimating the intelligence of the American people" indeed.

Posted by: TCinLA on April 12, 2010 at 5:58 PM | PERMALINK

You know, this is exactly the way that it used to work with fire protection: Your house would catch on fire, a fire crew would show up -- or not -- and they would bargain with YOU for how much they'd take to get your belongings out of the burning house.

The richest man in history, Crassus of Rome [of Spartacus fame], made his fortune in the fire rescue business.

Now, we have awful government-run, socialist fire protection, with lazy government employees, and no one makes a fortune off of the fire business anymore.

Posted by: phein on April 12, 2010 at 6:01 PM | PERMALINK

You know all those jokes which start with "a guy walks into a bar"? I can envision a whole new series starting with "a guy walks into a hospital, with a piglet under one arm and a duckling under the other..."

Posted by: exlibra on April 12, 2010 at 6:04 PM | PERMALINK

My radiation for lymphoma costs $40,000, although not that often. I'm a good cook. Maybe I can barter a couple meals with my oncologist.

Posted by: Spike on April 12, 2010 at 6:21 PM | PERMALINK

This is straight out of John Galt's perfect little world where everyone barters their goods and services.

Myself, I'm looking forward to trading my bumper crop of zucchini for the colonoscopy I need.

(zucchini not to be utilized in said procedure)

Posted by: lgerard on April 12, 2010 at 6:53 PM | PERMALINK

Barter, bargain, it doesn't matter. Physicians who have contracts with insurance companies, which is virtually all physicians, are barred by those contracts for billing anyone less than what the contract allows for like services. A doctor is committing fraud if he/she gives a cut rate to the uninsured patients he/she sees. You can give things called prompt payment discounts but you have to start from the amount billed being the same as the amount that would be billed to the insurance company for the same level of care and/or procedure (E&M code). But those discounts can't be a back door way of giving really cut rate care. For example, lopping 50% off of a bill just for early payment could be seen as fraudulent. How many more times do right wingers need to display their ignorance about the economics of medicine before we're allowed to just tune them out altogether?

[disclaimer: I didn't read all the rest of the comments before posting this, so apologies in advance if this has been covered already]

Posted by: digitusmedius on April 12, 2010 at 7:09 PM | PERMALINK

There are a couple good barter / trade sites out there. I use CL and Baarter.com - http://baarter.com

Check 'em out. WIth this economy, it's definitely worth taking a look to see if you can swap something instead of paying for it.

Posted by: Lisa on April 12, 2010 at 8:08 PM | PERMALINK

My Congressman suggested the same thing at a constituent meeting; this notion that you can bargain for lower prices and turn down expensive procedures is apparently one of the big conservative talking points. On the other hand, when one suggests that doctors be paid to have conversations with patients to determine their real wishes about end of life decisions before it is a necessity, the conservatives scream "death panel" and "Granny killer." If the medical establishment was delivering the end of life care that people really wanted and not that which they think they need to deliver to keep from being accused of delivering substandard care (or line their pockets) we could reduce costs greatly.

Posted by: Tired liberal on April 12, 2010 at 8:15 PM | PERMALINK

She thinks not only that the average person can sock away $20,000, but that it will pay for any medical care that they need. In reality, it would pay for maybe 2 days in the hospital, tops.

Posted by: Sue on April 13, 2010 at 12:13 AM | PERMALINK

Here's what the IRS says about bartering and the irony is it describes a plumber doing repair work for a dentist.


Here's the Dem talking point, more IRS agents enforcing bartering tax laws, since there will be a substantial increase in bartering. Of course they will come to your door armed should they have to confiscate something unfairly bartered by one side or the other or you failed to claim "fair market value". Then we will see the start of internment camps that will indoctrinate those who failed to comprehend bartering laws. All confiscated items considered goods will be used to house the interns. All persons who provided a service will be required to provide those same services for free to the general public in the form of community service. Landscapers will mow your lawn, plumbers will fix your pipes, carpenters will build houses, Drs will treat you and all of this for free, and more people will have extra money to stimulate the economy for those who strictly deal in cash and followed tax laws.

Posted by: flyonthewall on April 13, 2010 at 5:13 AM | PERMALINK

Bartering might include trading sexual favors for treatment?

Posted by: bob h on April 13, 2010 at 6:48 AM | PERMALINK

If she meant bargaining, then that happens quite often with plastic surgeons. The doctor tells you how much whatever you want will cost. S/he even gives you a sheet outlining the cost of each procedure.

You're going to pay cash because your insurance company won't cover what you want and cash is what the doctor accepts.

Then you move to a nice office where you discuss your care with another office person, someone besides the doctor, someone hired to bargain with you.

This person makes it clear that you would be stupid not to bargain. Maybe you could sign up --and pay a substantial pre-payment in advance -- for all the procedures you obviously need and get a discount. Or three iterations of one procedure might make a discount possible.

Bargaining with money. Not bartering with chickens. But obviously close to what the state senator was thinking about.

Posted by: modaca on April 13, 2010 at 7:26 AM | PERMALINK

This is Nevada. I think we all know what she was suggesting. Doctor, if you take care of me, I will take care of you...if you know what I mean. She is obviously suggesting offering quid pro quo, which is illegal. But the Sin State might have ways of getting around it. She is suggesting all women turn to prostitution to get their medical needs met. Nice.

Posted by: Patrick on April 13, 2010 at 11:38 AM | PERMALINK

We bargain with my wifes doctors on a regualr basis, and we do it with insurance in our back pocket! My wife has back problems and these doctors know that they will be making a lot of money through our insurance and they are more than happy to let the co-pays and deductable "slide" as they know she will put their kids through collage or buy that new Mercedes.

Everything is negotiable...even without cash.

Posted by: Jim on April 14, 2010 at 7:51 AM | PERMALINK

I've switched over to bartering recently for most of anything I can get without having to shell out cash. There are a couple sites out there to use, to connect with people who are looking to trade/swap items or even services (carpentry work for auto work, etc). One of the sites I use is Baarter.com - http://baarter.com

Posted by: Daniel on June 28, 2010 at 8:27 PM | PERMALINK



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