Doctor Curmudgeon: Ben Franklin and Me

doctor curmudgeon, dr curmudgeon

This week, the old Curmudgeon had a mental bloppo.

I seemed to remember that great gentleman, Ben Franklin, saying something about insurance not meant to cover every penny of everything.

After fruitless hours of searching, I could not find that quote.

I did know that, in addition to being one of our Founding Fathers, he was the Father of mutual insurance.

I was hoping that, being a certified curmudgeon, I could channel him on that point, but he must have been busy as there was a huge waiting line.  I did meet a few other curmudgeons, but that’s for another column

Serendipity is an interesting muse, because in the course of searching, I found an unrelated quote which I feel compelled to post here:

“No man’s life, liberty or fortune is safe while our legislature is in session”

*                                                   *                                                               *

My door was partially open.  As I sat in my office, getting chocolate crumbs on my keyboard, I heard goings-on at the front desk.

Assistant (a smile and gentleness in her voice):  “Ma’am, your co pay is twenty dollars.  Would you prefer to pay by cash or credit card?”

Patient: (sounding unhappy and upset):  “What? Twenty dollars?  I thought my insurance paid for everything? I pay a ton of money every month.”

It’s true; most of us pay a very un-pretty penny each month for our insurance coverage.

There are many, many, many who believe that insurance must cover everything.  But, to insure is to cover against catastrophe, not cover every single dime or penny or pence or ha’penny.

Where did we lose this concept?

My parents had insurance and I remember them paying what the insurance did not cover.  It was so simple then.

If they were short of cash, they could always discuss this with the hospital or physician and make arrangements to pay it off and, quite often, get a decrease in the amount owed.

And along with that old fashioned concept of what insurance is meant to be, there are precepts that have disappeared:

Don’t expect something for nothing.

Take responsibility.

Have respect for others.

Honor those who have done their best for you.

I am grieved that we pay so much to protect our health.

I am grieved that many of us can afford a small copay of twenty dollars or so, yet become annoyed when the physician’s office asks for it. We feel we pay more than enough to the insurance industry. Yet, that copay is part of the physician’s reimbursement

Yes, I am sorely grieved by this.  As, I believe, dear old Ben Franklin would be … If I could only channel the man.


Read Doctor Curmudgeon as she talks about “Yes Virginia, there is still joy in medicine.”


Diane Batshaw EismanDoctor Curmudgeon is Diane Batshaw Eisman MD, FAAFP, a Family Physician, writer, voiceover artist, and medical educator. It was in the Neolithic Era that the doctor became renowned for expertise in Trephination. After so much time in practice, Doctor Curmudgeon is now cranky and has rightfully earned the honorific of “Curmudgeon.”

Doctor Curmudgeon has no idea of what will appear in this space. It depends on the Good Doctor’s mood and whatever shamans and doctors are channeled at the moment.

As a curmudgeon, I may stray from what I observe happening in medicine and slink into other areas. But that is the prerogative of a Curmudgeon.  Please check out my first book, “No Such Agency.”


  1. says

    Great column. And so true. So many people don’t understand the concept of the co-pay. It is an agreement between the insurance company and the patient. By law, we are obligated to collect the co-pay otherwise we are violating federal anti-kickback laws. Definitely a frustrating point in practice. Thanks for sharing!

  2. Patricia says

    Does the physician’s staff advise the patient it is illegal to not request the co-pay? That takes the onus off the ‘mean’ physician and his/her ‘mean’ staff. In the meantime, pay a little extra for insurance to begin with and don’t have a co-pay.

  3. Colleague in Arms says

    Well, if one insures against catastrophe like a fire or a car accident or your ship being sunk by the Spanish Armada or captured by pirates then it shouldn’t cost you so much on an ongoing basis.

    That medical insurance does cost so much on an ongoing basis (and dictate every little thing about services and providers) is what makes people think it is not catastrophic medical insurance, but health care coverage.

  4. Ellen Kracoff says

    We are moving toward a world of “entitlement” NOT “enlightenment”. Many people think that since they pay for medical insurance, that should be all they should have to pay. There is very little difference between how property insurance and medical insurance is administrated. After the many hurricanes that we have experienced in Florida, and the millions of dollars in property loss, you would think the patients would understand the concept of a co-pay or deductible amount. Maybe the message is that they value and are willing to pay for possessions, but not so quick to maintain their own personal well-being. Pretty sad…..for the patient, as well as the medical practitioner.

  5. Siberian Summer says

    Elegantly written, a pleasure to read. I think that many people are unaware of just how expensive a catastrophic illness (or even a brief hospital stay) really is. Yes, it seems like it should be obvious, but they may not pay attention to their bills’ itemization, and are thus not aware of how much their insurance is actually saving them. This confirms my judgment that there is a crisis in critical thinking skills that has developed over the last 30 years, or so. It’s harder and harder to find.

  6. Forrest says

    I think health insurance should be transparently priced just as other insurance is.

    I recently purchased flood insurance for our home near the jersey shore. I was given the options of different deductibles at different rates.
    I could have chosen $1000, 2000, $2500, $5000, or $10,000 but ultimately settled on the $5000 as the best option for us to afford the annual premiums and survive if we had a catastrophic event.
    But, I know if we have a flood, it will cost me $5000. I am not happy about that possibility, but it was my choice.

  7. Joe says

    What an enjoyable thought provoking piece! Hopefully more people will now understand the doctor’s requrements to collect a co-pay.

  8. Eugene H. Eisman, MD says

    Back when I started my practice (in the Cretaceous Period). There was something called Major Medical Insurance. It was sold by Blue Cross etc. It was about $10,000 deductible, and did not pay for any routine stuff. I was intended for when you fall off your motorcycle and end up in the ICU. The stuff we have today is not real insurance.

  9. says

    I remember that kind of insurance, I think there was one I had that had one thousand dollar deductible.
    At least you would be protected for catastrophes

  10. lasermed says

    What’s always difficult in these discussions is that the person who doesn’t want to pay the $20 is standing there with a Starbucks latte, having just come from their mani-pedi. They are driving their gas guzzling luxury car, carrying their designer purse, wearing their designer shoes…… You get the picture. The doctor is trying to figure out how to pay for the kids’ braces, the malpractice insurance, and is there enough money to maybe buy a letter jacket for the oldest one for Christmas since he lettered in (fill in your favorite activity here)?
    I know, because I’ve been there. It’s hard to swallow what you want to say and be nice. One day, we are all going to NOT be nice. Watch out for when that happens, people.

  11. Margie Anton says

    It perplexes me that anyone can claim he or she is unaware of a co-pay requirement. It’s clearly printed on my insurance card. It states the amount I am required to pay for treatment: $30 for a standard visit, $40 for a specialist. All that is required is at least one eye and the ability to read. Most of us have that and pleading ignorance is no excuse. Just saying,..

  12. says

    first of all…………I do love all your comments and blogs. I think that any real physician in the real trenches of medicine finds so much commonality in your commentaries.
    As per insurance companies, I always was a great supporter until we lost everything a few years ago. At that time, we found out to our shock that the insurance industry in this nation is nothing more than a legal mafia. You see, the insurance industry, including car,health, home, etc, is exempt from anti trust laws. This is thanks to both political parties and both parties benefit greatly from the insurance industry contributions, both above and below board.
    And now that they have formalized their relationship with the government, we average people can expect to be screwed more and more in the years to come.

  13. Clara Wilkerson says

    When you think about Ben Franklin what immediately comes to mind for most of us is Founding Father, signed the Declaration of Independence and the U.S., Constitution, his lightning experiment, U.S. ambassador to France, publisher, scientist, statesman, his many inventions such as the stove and biofocals, (Thanks from the bottom of my heart for the specs doc!) and totally uber-enlightened genius. However, health care is not a common association. Yet once again our Dr. Curmudgeon has made this critical connection. Ben Franklin joined forces with Philadelphia surgeon Thomas Bond to found the nation’s first public hospital, to provide free health care for the city’s poor and sick. Franklin had a great interest in medicine and personal responsibility. I wonder what Ben Franklin would say about Obamacare and the state of health insurance today? Stop rolling Ben… stop rolling.

  14. says

    Thank you, Clara, for your enlightening comment. Appreciate the comment especially from someone like you, journalist, Tv producer, former anchor and reporter…thank you again

  15. says

    Dr. Eisman: I do appreciate your wonderously wise words of witticism and noted with humor efforts to channel our “Colonial Da Vinci” Ben Franklin. To say he was an interesting man is an understatement: Patriot, inventor, ambassador, author and an oft forgotten dimension, advocate for affordable health care.

    History tells us he acted on this, and as colleague Clara noted in her enlightening commentary, was instrumental in establishing a hospital in Philadelphia for the disadvantaged.

    I will leave you with this observation: As imperfect humans, we will inevitably experience health issues that range from the benign to the life threatening, and I will forever take umbrage at a healthcare system, unlike the free systems in other advanced countries who recognize the value of the ultimate resource – the human resource – that seeks to profit from unavoidable physiologic disorders.

    We can do better as THE world power…

    Myron D. Stokes
    Publisher, eMOTION!

  16. says

    Dear Mr. Stokes, I am so appreciative of your own enlightening commentary. Thank you. thank you.
    And I do love your “handle” I assume it is derived from Isaac Asimov, one of my favorites

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