I recently found out that my dr. (an hiv specialist) is now offering "better treatment" when patients pay by cash instead of insurance. Such things as longer visits, priority for referrals, more options for appointments. Is this legal? Is this ethical? I'm not sure how I feel about it but I don't have the funds available to pay cash for my healthcare (drugs are bad enough). There also aren't that many choices for hiv specialists in my area. Is this what the medical profession is coming to? You have to have cash to stay alive?

Hello,

The U.S. healthcare system is a total mess. Nothing about it is fair or equitable. Is what your doctor doing legal? Yes. It is. Is it ethical? That depends on one's perspective. Is it ethical for insurance companies to deny payment to physicians or reduce payments to levels that make providing care difficult for some doctors, particularly cognitive specialists? Cognitive specialists are physicians who "think" more than "do." For instance, surgeons can charge a reasonable fee for performing surgery. Fine. However, an HIV doctor who needs to interpret complicated resistance tests and figure out complex drug regimens and deal with difficult psychosocial issues often cannot charge for his expertise, time and service. The insurance companies refuse to pay. So the ethical question is complex. The answer is to elect Obama and get universal healthcare for everyone, like every other civilized industrial nation on the planet.

Talk to your doctor about your needs, but don't fault him for trying to stay in business within a healthcare system that is terminally flawed and presently surviving only on life support!

Do you have to pay cash to stay alive? No. You have to vote Democratic.

Dr. Bob