Being as it were that Ms. Lowden is probably headed to the Senate, I really hope someone sits her down and explains that health care policy doesn't work this way:
The feathers are flying in the political attacks over Nevada Republican Senate candidate Sue Lowden's declarations that people could control health care costs through the use of barter.
On Monday, Lowden doubled down on the barter idea. "Let's change the system and talk about what the possibilities are. I'm telling you that this works," Lowden said. "You know, before we all started having health care, in the olden days, our grandparents, they would bring a chicken to the doctor. They would say I'll paint your house."
This idea demonstrates a fundamental lack of knowledge of how the current health care system works. I know essentially nothing about Sue Lowden, and I'm willing to admit the possibility that she's a smart woman. But she should not be demonstrating such blatant ignorance.
The only kind of provider that could possibly accept chickens (or any other non-monetary form of compensation) is a private practitioner who owns his or her own office and takes no insurance. (I'm not even totally sure that it would be legal in that case, though I'm not aware of any specific law that would prohibit it.) Back when our grandparents were seeking care, that kind of provider was the norm. These days they are very much the exception.
Once you accept third-party payers of any kind, you are obligated to charge all of your patients the same fees for the same services. You cannot charge insured patients more, or accept non-monetary payments from uninsured or underinsured patients. To do so violates the contractual relationship providers have with the public and private insurance companies, in essence making them subsidize the care of patients not enrolled in their plans. To undercharge based on ability to pay is fraudulent, so I am obligated to document and code for visits uniformly, even when I know the family will have a hard time affording my fees. (Situations like this formed the foundation for my support of the health care reform package recently signed into law.)
Lowden's suggestion was just completely out of touch with how the health care system works. Someone really needs to make sure she closes this gap in her knowledge before she is sworn in.