When patients barter for health care

Dr. Fizzy McFizz

Here’s the famous TV interview response that arguably cost Republican challenger and former state senator Sue Lowden the nomination to run for the 2010 U.S. Senate election in Nevada.  When asked about a mildly eccentric suggestion she had previously made that patients should haggle and barter with their doctors to save money on their medical bills, Lowden replied:

“You know, before we all started having health care, in the olden days, our grandparents would bring a chicken to the doctor. Or they would say ‘I’ll paint your house’.

“In the old days, that’s what people would do to get health care with their doctors.”

But it turns out that her “bring a chicken to the doctor” suggestion may not have been all that goofy after all. 

Bartering for health care services is indeed a growing phenomenon in the U.S. as more health care providers are offering  patients the option of paying for the non-covered costs of medical and dental care without a direct exchange of cash. Think of it as reality meets creativity.

There are two types of health care trades that are growing. These are direct exchanges, where the provider and patient work out specific deals if the provider is open to bartering directly with patients, in person or through sites like Craigslist. And there are barter exchanges, in which member clients earn and receive points or “trade dollars.” 

These exchanges allow members to trade goods and services with other exchange members, generally for these trade dollars. They can then use those dollars to pay a health care provider who also belongs to the exchange. There are now about 400 such exchanges in the United States.

Rob Benson, vice president of ITEX, one of the largest U.S. examples of the latter, says that dentists, optometrists, chiropractors and podiatrists are among the most popular swapping specialties. He claims:

“Health care is definitely one of the most widely used services.”

Larry Usner runs Louisiana Barter, another independent trade exchange based in Lafayette. He says that he has personally covered the costs of insurance co-payments for his six angioplasty procedures, plus his dentist’s bill for $8,000, by swapping services from the radio and television advertising business he owns.

Charles Archer is the CEO of United Barter Exchange. He’s seen bartering for medical services increase in popularity by three to five times in the past few years. One third of all transactions last year involved medical services.

“Three years ago, clients didn’t even care if I had medical to offer. Today it’s my #1 request. It’s trending up because people have a lack of insurance and a lack of cash.”

And here in Canada (better known as “commie pinko land of socialized medicine”) we don’t have to worry about paying big medical bills like our American friends, but we do have barter clubs such as the  Vancouver-based First Canadian Barter Exchange, where members provide health-related services like orthotics or physiotherapy to fellow members. Providers can then exchange their trade dollars for anything from power washing the house to getting a new family dog.

A FRIENDLY REMINDER FROM THE TAX MAN: In both countries, remember that those who engage in bartering on a more-than-occasional basis may be required to pay taxes by reporting “income” based on the value of the goods or services you’re providing. Keep track of the trades you make, and keep good records of them. But many businesses can claim these expenses to offset some tax liability, and if your extra barter dollars are donated to a qualifying charity, these dollars may qualify for a further tax deduction.

Small business owners seem particularly open to partnering with barter exchange organizations. Credits received by a dentist, for example, can be exchanged for goods or services he or she selects – from office cleaning to restaurant meals.

It’s a process that has worked well for Dr. Mark Frankel, a Florida dentist, who says:

“I have used bartering for vacations, painting, contracting, hotels, air fares, massage services, medical services for myself, anything really!”

There’s always been a tradition of bartering for health care in rural areas, as the late Ron Nelson, a physician assistant and co-founder of the National Association of Rural Health Clinics, once told NBC News.   In more than 30 years of setting up and working at rural clinics, he said he’d been offered a strange range of payments for his PA services.

“I’ve received everything from chickens to vegetables. I’ve had people cut up logs for me. And the  current recession has left more people more desperate, which may be driving the surge in alternative payment arrangements.

“We’ve seen a significant increase in people with no resources.”

Consider also the O+ Festival. It’s a three-day celebration of art and music held in the Hudson Valley town of Kingston, New York.  But it’s actually far more than that. Organizers arrange trades of medical and dental care for music and art.

Joe Concra, a Kingston artist who helped start the festival a few years ago, explained that it all began when he met a dentist at another music festival who really liked the band called Monogold.  He wanted this band to perform in Kingston, and told Concra:

“I would clean their teeth and fill their cavities if they came and played.”

Inspired by that comment, Concra contacted Dr. Art Chandler, who ran the Emergency Department at the local hospital. He told Concra that he knew some doctors who love music who might also be interested in this idea, too. Concra explained:

“We altogether said this is crazy, but maybe we can pull it off. The way we got it going was with a few phone calls to different musicians, different artists, and different doctors. We had a meeting, then another meeting, and four months later we had the first festival.”

The O+ Festival is now an annual event over the Columbus Day weekend that includes participating artists and musicians who barter their contributions to the festival program in exchange for medical, dental, and other wellness services from art-loving health care providers. It’s been described as a grassroots, band-aid solution to inaccessible healthcare for the creative community.

Concra added:

“We say that we don’t provide health insurance, we provide community reassurance.”

Cartoon via Dr. Fizzy McFizz

Q: What’s the best thing you’ve ever bartered for?

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