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.

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Posted in: Thinking Straight

This article has 5 comments

  1. doc john Conrardy 07/20/2016, 3:21 pm:

    The major benefit of a cash practice? You do the best for your patients because YOU are the Chiropractor without any obligations other than your patient. It is liberating!

  2. Joe Donofrio 07/20/2016, 4:58 pm:

    For me GPC, the box, was and is all about FREEDOM. I give Chiropractic to all who want it and the Universe is free to reimburse me according to my needs. after 50 years it still works and always has…..amazing, I’ll admit, but it does work.

  3. william hollensed 07/20/2016, 5:06 pm:

    People mistakenly thing insurance is designed to pay for their care. It is not. It is a business and answers first to shareholders. Prices have escalated because provider like getting more and insurance companies like high health care costs to scare you into buying insurance.

    Chiropractic should be between the doctor and the practice member. If they understand they will pay a reasonable fee. Since we cannot prove regular chiropractic care makes you healthier we need to sell it to the one who needs it (everyone).

    I started out in 1971 at $3 a visit. I made it. Today I would do membership practice where they paid per month and it was up to them to get in for care.

  4. Ronen Mendi 07/27/2016, 11:56 am:

    Thank You Joe.
    The big problem that I see w insurance, is that they pay for a minimal care of medical conditions, not for chiropractic service, nor for Chiropractic understanding. The reason we should not be part of the insurance game is, that is played under medical thought. It does not work with chiropractic understanding of correcting subluxation as the purpose of Chiropractic care. Not the treatment of symptoms.

    • Joe Strauss 07/27/2016, 2:23 pm:

      Good Observation! We should also note that the purpose of the subluxation correction should be noted. As Reggie use to say(I paraphrase), more subluxations are corrected to accomplish a medical objective than to enable the innate intelligence of the body to be more fully expressed.

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