Physicians across the country are attending seminars that teach doctors how to start their own direct primary care practices. Direct primary care practices take no health insurance, only cash. In a recent survey conducted by the DPMA Foundation, 2 out of 3 doctors say they are “just squeaking by or in the red,” and 83% say they are “thinking about quitting the business.” With the looming threat of Obamacare, many doctors are planning to ditch the traditional business model for a more simple and straightforward one.

Dr. Jerome Aya-Ay from Palmetto Proactive healthcare in South Carolina uses the “Direct primary care,” model which is successful because it eliminates the bureaucratic hassle of insurance and lowers prices for the consumer.

Dr. Jerome Aya-Ay charges his patients via a price list similar to a restaurant menu. He also charges a monthly fee of $60 for routine services which most doctors cannot do. Listen to the interview below.

Chiropractors have been using the cash only business model for many years and are experiencing great success. Dr. Scott Baker, owner of Upper Cervical of Spartanburg, S.C. said, “We started to go 100% cash in May 2012 and are experiencing great success, now we are moving into a state of the art facility 3 times bigger than our current venue, and we will be hiring a new doctor.” Dr. Scott said he is creating a patient-driven practice. His new clinic will have a “health-spa feel” with digital touch screens for patient check-ins, flat screens TVs, and a paperless office so he can have more time to focus on his patients.

The Heritage Foundation’s Ed Haislmaier said, “I think we are going to see primary care doctors increasingly moving to a cash-only arrangement, where they opt out of insurance rules.” The simple truth is that doctors want to get off the insurance grid not only because of the risky regulations and economic factors, but because they want better relationships with their patients.

Dr. Tom Kendall of Greenville, S.C., a practicing physician and the president of the Association of American Surgeons and Physicians said, “Obamacare is not about healthcare, it’s about control. Obamacare puts the relationship of the patient and physician under the jurisdiction of the government. This means more government control and less patient choice. Under Obamacare, healthcare will be rationed, healthcare costs will increase, and bureaucrats will decide medical treatments instead of the physician and patient.”

Upstate doctors who are moving to a direct primary care are creating win-win solutions for medical professionals and their patients. It would be a move from a bureaucracy-driven model which is enamored with red tape and creates a wedge between the doctor and patient, to a patient-driven model with no insurance interference, less government intrusions, and no wasted time dealing with paperwork. It is a model that will create lower fees for patients and will allow doctors to foster better relationships with patients. The real solution to healthcare is to give patients more control over their health care dollars, and unchain doctors from the shackles of government control and regulations.

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Joshua Cook

Joshua Cook is a writer and reporter for Truth In Media. He has interviewed many politicians including Rand Paul, Ted Cruz, Walter Jones, Bob Graham, Trey Gowdy and thought leaders who shape U.S. policy. He is a host of 'Beer and Politcs' on Truth In Media. If you have any tips please email him at Find him on Twitter @RealJoshuaCook

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    Here’s a question: when a patient goes cash, will there be records keeping/data/input into the federal system? OR will the MD/health care practitioner be able to avoid the e-records for that cash patient? cash patients want the old NO E-RECORDS system.
    Cash patients are paying for privacy as well, no?

    • kenvandoren

      One can only hope this is so. One problem I see is that there are so few independent practices any more. Hospitals may not grant privileges to physicians who are not practicing within preferred clinics, and the paper work is so onerous, few new physicians will go into independent or small clinic practice.

      • Palmetto Proactive Healthcare

        Omnibus Health Insurance Portability and Accountability Act, or the HIPAA rule. Medical offices and business associates have until September 23 to comply.

        When patients pay for services personally and in full, they can require that the office not share information about the treatment with their health plans.

        • GENUG

          Thanks!! I’m in!

    • drmikevasovski

      Definitely! We keep paper records only. With nothing filed with the insurance company, the diagnosis codes don’t leave the office either. Last step, go the Walmart, Kroger or an independent pharmacist who takes cash for the Rx and you are done.

      • GENUG

        love it! back to the “old days” – I’m in!! anyone in Westchester, NY?

  • F Plang

    Great article!! Keep it up

  • J Stevens

    I work in corporate healthcare and a couple doctors I work with have been planning this type of clinic. Cash or credit, and prices for all procedures/exams are on the web site and in pamphlets. The prices would be dramatically less compared to corporate run clinics/hospitals.

    • Katrina

      Hi CJ,
      That’s great, I work for a company that help facilitate telephone consultations for a fee to patients when their matter can be handled over the phone vs. a visit. Would love to connect, you can reach me at

  • Shane

    I really like the Palmetto Proactive subscription plan thing. It’s genius, and I would DEFINITELY pay $60 a month if I got all of that. As it is, I haven’t been to the doctor in several years. It would cost me $220/month to cover just myself if I bought my work’s health insurance. With a $200/month food budget as it is, that’s just not doable.

  • Glenn

    I love the idea of this. The bigger problem is that this will have no effect on the high costs of prescription medication. Would still probably have to have something similar to Medicare Part D to deal with this, unless all the cash clinics like this were able to group together to negotiate better pricing.

    • drmikevasovski

      Walmart, Kroger and now many independent pharmacies are doing $4 a month or $10 for 3 months on 300+ prescriptions. Over 95% of visits and basic conditions can be handled with these medications. Independent pharmacists will negotiate like crazy to get your business.

  • Elizabeth Sacks

    I LOVE this! I just wonder how I can find Doctors doing this in my area.

    • Palmetto Proactive Healthcare
      • Steve

        just fyi canceling employer provided health insurance(if you are considering it) can be difficult. I am finding that it may take waiting for open enrollment period.

  • stupid o’care

    This is fine and dandy, but what happens if you have a major medical issue? Now you are on the hook for hospital costs, and if you cannot afford to pay the thousands of dollars, then thats just more costs the people will be responsible for. I can see some benefits to this, but I also see a lot of potential problems here. We would still be required by the government to have coverage, so why pay extra cash to see an outside doctor? Not sure about this….

    • swinginmonkey

      I see a cash only doctor, still have employer insurance, and still pay less per visit than WITH insurance. I kept seeing that my insurance was being charged over $500 a visit (for non wellness checks), causing my 20% to be over $100…my cash only doctor charges $75 a visit no matter what the cause, so it’s cheaper and I don’t hesitate to go if i need to. I’ve been able to drop my employer insurance to the cheapest lowest plan as a safety net in case of catastrophe…it can work man, it can work.

    • Terry_RN

      That is why you carry only catastrophic health care insurance. It’s much cheaper than regular health insurance.

      • StrangerInAStrangeLand1

        Due to ACA, catastrophic health insurance will only be available to under 30’s. They want to make sure you pay high premiums.

  • Enthusiastic

    This is the answer! A free market system that deals in cash. The patient can save 80% due to the elimination of useless records and overpriced insurance. Somehow, this seems like the system that we had when I was a little guy.

    Couple this with prevention and we can have a much healthier citizen base with more money in their pockets and the pockets of their doctors.

    • nomark

      This WOULD be the solution if it existed. But it does not. You pay more for cash services than you would if you had insurance.

  • Kevin Merck

    Health insurance is about jobs. When everyone who wanted to work, could find a job, health insurance was something almost all employers offered as part of the compensation package.
    Send all the jobs overseas and now no one has any health insurance.
    Health insurance needs to take a back seat to bringing the jobs home. Nothing gives the government more control than having a huge portion of the workforce on the government payroll and millions of people on welfare.
    The reason they sent all the jobs overseas in the first place was to enslave us.
    Who the hell cares about seeing a doctor when you’re nothing but a slave?

  • LetsTryLibertyAgain

    I’ve been dreaming about more free market forces in health care, not only for lower costs, but for better service. I try to avoid going to the doctor’s office but when I do, I’m disgusted by the fact that they have twice as many employees filing insurance and government paperwork than they have providing healthcare.

    My wife is constantly on the phone with insurance companies. They automatically deny everything at first. Sometimes, they’ll deny everything two or three times. Then they lose your paperwork and you need to start over. Eventually, they offer the medical provider pennies on the dollar. That’s why the medical providers charge so much, so they can afford to offer the huge insurance discount.

    The maddening part is, I want to be a cash customer. No haggling. No paperwork snafus. I’d pay when service is rendered, like any other free market exchange. You’d think I’d get a cash-payment no-hassle discount, but I don’t! I’m charged the full inflated price for paying up front with no protracted hassles. The large discounts are reserved for the insurance companies!

    What other industry charges an additional 150% to 200% more for cash payment? It’s insane. The only recourse is to be treated, not pay, don’t present insurance, make them wait and hound you, and then they’ll offer you the insurance discount, or close to it.

    I guess Obamacare has finally made the entire corrupt healthcare system so dysfunctional that the free market once again emerges. Yeah, Obamacare!

  • Jeff Brodhead

    If I remember my reading of portions of A.C.A. correctly, DOCTORS CANNOT LAWFULLY TAKE ANY PAYMENT DIRECTLY FROM THE PATIENT.

    No cash, credit card, or other forms of payment will be allowed in the COMMUNIST BULL CRAP PILE OF MANURE CALLED “OBAMACARE”!

    • JD

      Havent heard that- but if that’s true theres getting around it. Doctors do not have to directly accept payment. Instead they can setup a trust fund that wires all money directly into the fund. Essentially the doctor is not receiving the money. THe trust is. Even if he is the beneficiary. =)

      • Free To Contract

        If the Doctor contracts to take your mandatory insurance, then he cannot ALSO take direct payment. However, if he decides NOT to contract with insurance companies, then he is certainly free to contract directly with YOU, for any fee or price the two of you agree on. He can offer his work, and you can take it or leave it. If you think the price is too high, you are free to take your business elsewhere. And when you get to the office that takes your insurance, they will smile, point out that you only could afford the cheap insurance with the $5000 deductible, and ask you for your cash payment. And you will realize you are paying $1000 a month for your insurance tax, and still paying for your office visits.

  • steve

    Well I have a double, my mothers Dr is “retiring” and the Dr that is taking over the Patrice is cash only $1500 a year, and I like it, because she can afford it, as it will mean a smaller client list and more personal care, to bad the unintended result is the average medacare subscriber is screwed, just wait till most private hospitals go this way… that said, I would love to pay my premium dirct to the hospital that will be taking care of me and all the hospital has to do is give a rider for their clients that would allow emergency care when one was out of town… boom

  • johnny

    What happens in cases of malpractice? I was under the impression that’s a big reason why healthcare costs so much, is liability insurance.

  • Nate B

    I do think this trend is going to increase. A DPC clinic just opened up near me, in small-town Missouri. Should be good for everybody.

  • Mickie Repecka

    Is there a list of doctors doing this? I’d like to find one locally.

  • James W

    This is great, IF you have the money. Aside from the fact the folks that cannot afford to pay up front getting screwed as usual, what about these BS laws that require you to have insurance no matter what? So we’re going to pay for insurance we’ll never use, and the doctors won’t take anyway? How is this better for the average patient? Sure, the doctors get better pay, and the quality of care goes up, but the cost to the patient is still out of reach for the average schmoe, so how it this better?

    • SKH64

      Here is the idea, James. If we claimed every grass cutting and snow removal on our homeowners insurance, that would be through the roof just like healthcare’s monthly payments. Insurance is for the stuff you can afford to pay on your own. We (society) needs to stop claiming every little sniffle we have with a doctor’s visit. THEN the cost will come down. Some how we have gotten in the mentality we need to see a doctor because we have insurance. Well that keeps the cost up. We are losing our insurance. Obamacare is going to be more expensive. We are looking at policies that have a very high deductible to keep the monthly cost down. That way we are getting help with it is a real financial burden. We are paying for our maintenance stuff ourselves, because that keeps our premium down. The other option is not having insurance being a cash patient. Then you will not go in for every sniffle.

  • sarah

    Does anyone know how to find lists of doctors who take cash only? I’m in the Cleveland area and I’m having a hard time finding any on google….

    • SKH64

      I would ask your current doctor. When I did, mine said he had a lot of cash customers. Most were self-employed contractors like my husband. Ask for a discount. If they say no, then tell them you will need to find someone who does offer. They will change their policy or lose you as a patient. Which do you think they would like to do? Besides, cash patients are less time for them in doing paperwork. I don’t know any doctor who wants to do paperwork, especially from the government. The less paperwork they do, the more billable time they have to see someone $$$

  • nomark

    This story is pure BS!

    I have almost always tried to pay cash for any medical treatment, but these doctors and hospital SCREW cash paying customers. I have countless bills that when I tell them I’m paying cash are 5 to 10 times the rate I’d see if I had insurance. It just so happens I do have insurance. When I submit the bills to the insurance company, amazingly the rates drop by 30-80% for the same procedures. It’s a scam by the medical industry, government and insurance companies to push people into this socialized health care system. Which will eventually lead to a completely socialistic country.

    And this is not just me. John Stossel did a story on this exact issue a couple of years ago and found the same results.