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On the Third Hand: Barter

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Some of you are trying to “diversify sources of revenue” (get money more different ways) by selling more of this type of insurance or that type of insurance, or this or that type of analytical services.

What about having a long, in-depth conversation with your state’s regulators (maybe organize a trade group panel discussion?), and, if the regulators don’t freak out, consider bartering something for something else?

Or (if this considered legal and ethical — I’m not really sure) try hooking up employer clients with unmet benefits needs experiment with monitoring?

I have no idea how well this would work, in practice, but it just seems to be an interesting idea. It would be great if some braver, more energetic, better-situated soul woud try it and report back.

The thought came to mind today as I was interviewing Nicole Graham, the senior trade director at Trade International Exchange, a new, Miami-based barter exchange that’s hooked up with a network of about 100 other barter exchanges.

Graham, who’s been in the barter business for 10 years, said most barter exchanges sign one or two health care providers. Trade International has made a splash, especially in Florida, by making an aggressive effort to recruit and promote members that offer products and services.

In theory, the Trade International exchange and other exchanges in its consortium can provide access to a total of about 30,000 health care providers.

A primary care physician practice that has too many unbooked appointment slots on Tuesdays could, for example, trade Tuesday checkup slots for help with administering its small but surprisingly confusing micro-group health plan. 

A carpenter could trade bookshelves for an MRI.

Regulators have told Trade Exchange that letting exchange members barter for health care services is fine, Graham said.

“We’re just third-party recordkeepers,” Graham said.

Bartering for health care has a long, honorable history.

Robert Heinlein wrote in some of his books about his grandfather, Dr. Alva Lyle, an old-time physician who collected many of his fees in the form of fresh chicken eggs.

I have personally met a medical biller who reported that she has worked for a physician in Queens who gets much of his compensation in the form of Middle Eastern cookery.

Of course, success at getting health care through a formal barter exchange may depend on factors such as how effective an exchange is at signing high-quality, convenient health care providers. People developed money in the first place because having money that you could can spend on any product or service that you desire tends to be simpler than having to use “exchange dollars” to buy the same products or services from other exchange members.

But barter can be a good way for getting the invisible hands of supply and demand to meet when suppliers think the value of what they’re supplying is much higher than what the buyers can afford to pay.

In today’s deflationary environment, barter may play a different role: Helping barter exchange members conserve scarce, previous cash.

“People are terrified of paying cash out of their pocket,” Graham said.

On the one hand: It’s a lot easier for me to brainstorm about this than it is for anyone out there to actually try this (and to get blessings from all of the regulators, accountants and lawyers who ought to be consulted).

On the other hand: If you, through your work as a health insurance broker, plan administrator and chamber of commerce member actually know a lot of underemployed health care professionals, other professionals and merchants with excess merchandise, maybe it would be fun to work with a well-run barter exchange to add a well-promoted health care services component, just to see what would happen. Maybe, for example, concierge service package barter could be a way for doctors to avoid feeling the effects of any Patient Protection and Affordable Care Act (PPACA) physician reimbursement storms while protecting member employer employees from having to wait 10 hours in a physician’s waiting room for a checkup. 

On the third hand, a well-run, well-promoted health care services barter program could be a blow to someone’s ego. Maybe, trade exchange members will find that traditional acupuncturists actually have a higher barter value than the services of physicians who’ve gone through 24 years of brutal residency training, or that, sadly, all of the curios in a cute little antique shop really aren’t worth one simple dental implant.

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