Brock Cusick forwarded this CNN article with the very appropriate comment "when the regulators get tough, the tough go cash in hand."   CNN is describing a micro-trend in medicine back towards all cash doctors & payments.  

...When O'Brien leaves the exam room, he writes a check for $50 and he's done -- no forms, no ID numbers, no copayments.

..."It's a terrible indictment of the collapsing health care system," said Arthur Caplan, chairman of the medical ethics department at the University of Pennsylvania Medical School. "Insurance and managed care were supposed to streamline -- instead what they've done is add so much paperwork and bureaucracy they're driving some doctors out."

..."There is a great intrusion by third parties into the patient-physician relationship," Nelson said. "We can understand their frustration."

... [he] sees fewer patients now. His whole office would probably fit inside his old waiting room. But he says the freedom is worth it."  Accounts receivable is zero. It's a great feeling," Cherewatenko said. "I feel like I'm a real doctor again."

..."We said, 'Let's cut out this administrative waste,"' Cherewatenko said. Before, he charged $79 for an office visit and got $43 from an insurance company months later, minus the $20 in staff time it took to collect the payment. Now he charges $50 -- and he never worries about collection costs, because patients pay in full after every visit.

... The patients who pay cash range from poor to wealthy, with most in the blue-collar middle.  "When I first started, I thought it would be the elite. That's not the case," said Dr. Shelley Giebel, an obstetrician-gynecologist in Temple, Texas, who washed her hands of insurance eight years ago.

...Cash crusaders acknowledge the need for some type of insurance. Without it, expensive surgery or hospitalization would force most people into bankruptcy. But they think health insurance should work more like car insurance: you pay for the routine maintenance and little dings yourself, and insurance pays for more expensive repairs.

Somehow, I think it's safe to say that when Bush, and especially Kerry, talk about reforming the medical system, this is NOT the direction they're thinking of taking it in - both are inclined towards increasing the involvment of the biggest, most clumsy 3rd party of them all - Government - into this most intimate relationship.   The largesse that Bush is visiting upon Seniors, Kerry wishes to extend to all.    The thought of HillaryCare positively gives me hives.

What I particularly liked about this story is how well it illustrates the deep, intrinsic relationship between economic rights and Freedom.   This isn't just Freedom in some abstract, legalistic sense but rather in the  visceral, day-to-day, emotional Quality sense.  The individuals on both sides of this transaction *feel* better about almost every aspect of it -- what could be more Fukuyaman & identity expressive than "I feel like I'm a real doctor again" or the patient who now feels like he's "loved"?   The emotions on both sides are inescapably the direct result of the transaction being reduced to its most raw, stark economic terms - an all cash transaction.  

It's intrinsicly hard to legislate & enforce what constitutes a higher Quality transaction and, as with aesthetic authenticity, we nevertheless recognize one when we see it.   And it's precisely this unspecifiability that makes it so hard for clumsy instruments like Government to produce products & services that possess it.   Chalk it up to the "revealed Knowledge" that Hayek said consumers possess in bounds and that legislators & other would be busy bodies are completely blind to.