After a few minutes, the doctor appears and walks a patient to the door. Then he turns to the woman. She pulls her scarf back and reveals a mole. "I've had it my whole life," she says, standing by the door; it was always brown, but now it has turned red.
"It's just a scrape," Ores tells her, taking hardly a moment to examine it. He jokes that a gnome may have done it, and they ought to hunt it down. As she puts on sunglasses, he identifies the temple arms as the likely culprit. He opens the door for her, belaboring the gnome joke as she departs. No money was exchanged, no charts filled out.
"I'm a neighborhood country doctor," Ores told The Villager several years ago, "in an urban setting."
Patients pop into Dr. Ores' office "all the time" for quick questions like that. (Otherwise, he sees about 20 or so patients a day, on average.) If she—a neighbor and regular patient, whom he would examine, he tells me, more thoroughly during a more formal subsequent visit—had gone to an ordinary doctor, or a clinic or a hospital, for such a potentially minor query, it would have cost hundreds of dollars (not to mention all the paperwork that would have to have been filled out and the man hours devoted). If she were lucky, if she had health insurance, such a bill might not be such a big deal. But over one million New Yorkers lack health insurance and thus can't afford such visits. And, anyway, as Ores tells me again and again, the health insurance industry is a sham.
"It's a national disgrace, to put it mildly," he says. "It's the biggest scam since the world was flat." His favorite metaphors when discussing it are slavery and apartheid. But, as a doctor, he doesn't just have to gripe or grind his teeth about the state of medicine. He can do something about it.
Ores, known affectionately as "Dr. Dave," has been operating as a general practitioner (and tattoo remover!) out of his modest office on Clinton Street, on the Lower East Side, for roughly 15 years; he had an office on the corner of East Houston for about eight years before that, but his landlord did not renew his lease. ("Bars make more money," he surmises.)
He treats anyone who walks in, regardless of insurance—in fact, he sees himself as a "conscientious objector" to the health insurance industry. A dusty sign in that blood-red waiting room lists his prices: $350 for first-timers, $250 for repeat-visitors. But, unlike most physicians, Ores doesn't try very hard to collect outstanding balances, making him a de facto pay-what-you-can doctor. His home and office rent are low-income-each cost him less than $1,000. "That's how I can afford to do this. If I was paying $6,000 a month, I couldn't do this. I'm not wealthy. If I were, I'd work for free."
His latest project is a restaurant-worker's healthcare cooperative, under which a network of restaurants pays in an affordable monthly fee and, in exchange, any of those restaurants' workers can pop in and see Dr. Dave, whether it's to treat a cold or a sliced-open finger. His model is a small version of what he hopes to see on a national scale. "It's a demonstration in practical terms," he says. "We have to make our own National Health Service until there is one."
Ores lives in apartment on Avenue B, down the street from his office. It's boldly colored, like his waiting room, and the ceiling is covered in tacked-up Oriental rugs. A tattoo magazine sits on his coffee table, alongside an unopened bottle of wine, a candy dish filled with Starbursts, and a box of cigars. He lights one shortly after arriving home from work, and, while a shuffling iPod runs through an eclectic mix of jazz, hip-hop and rock n' roll, spends the next few hours smoking and explaining his well-considered thoughts about healthcare, as though he were a stumping politician.
Ores, 51, is stocky, with a shaved head and thick arms covered in tattoos of mermaids, among other things. He was born in Manhattan, raised in Leonia—a small town in northern New Jersey—and attended college in Ohio. (Where, he mentions off-handedly, he was a state Judo champion.) He graduated from Columbia Medical School in 1985, after which he did his residency in Summit, NJ before cutting his teeth in emergency rooms.
His parents, both Holocaust survivors who met in Switzerland, spent their lives in medicine, but Ores didn't get the calling until college. First, he tried his hand at restaurant work, as well as unloading trucks. "I don't like to lift things," he tells me. "Work is really hard." Doctoring suits his hyperactive personality: everyday as a doctor is different; though the patients' problems are always the same, the stories behind them change.
Perhaps it was the time Ores spent working in restaurants that made him sympathetic to the uninsured waiters, busboys and kitchen staff. But it was also the empirical evidence of a broader problem he witnessed every day. For ten years, he says, he noticed he was regularly treating restaurant workers. Restaurant didn't see the larger pattern: only one or two of their employees might get sick at any given time, but across the industry that amounts to many ill workers, many if not most of whom don't have the insurance or the resources necessary to see a doctor. "These people are not served," he says. "You don't want sick people in your restaurants."
Restaurant management often can't afford to pay for traditional health insurance; the workers can't either. But Ores' rates are affordable, because he isn't out to turn astronomical profits. "We don't have any middle person," he says. "That's the magic part." And, as a large group, they can focus on preventative programs: they can negotiate prices for something like flu shots, or take collective advantage of free programs, such as the no-cost mammogram testing the city sponsors every year.
Health insurance programs, on the other hand, are a racket, in Ores' eyes. The doctor's most astonishing contention is that rates of illness and injury remain level over time. For example, he says, the percentage of elderly women who break their hips in New Jersey, relative to the population, was in 2000 what it was in 1920. (Give or take five percent.) As such, the health insurance companies know how many people will suffer from an ailment, and thus how much it will cost to treat them.
But they collect payments that exceed this amount by a large factor—not just to pay for administrative costs, but to line the pockets of executives. Insurance companies don't publish their profits, Ores said. (A quick Google search seems to refute this.) "It's probably too obscene to be spoken out loud." He pulls out his iPhone and tries some rough calculations, arriving unscientifically at trillions a month in revenue across the industry. He notes the Civil War was fought over far less money than that—so you can imagine the fight the industry will put up to survive. The C.E.O. of Oxford, he said, makes something like $100,000 an hour. "What the fuck does that guy eat?" Ores asked. "Unicorn dust?"
Health insurance, Ores explained, operates under a casino model: the house always wins if enough people play; much more money is collected than is paid out. Dr. Dave isn't a Communist: he's not against people making large profits. He just doesn't think they should make it off of people's health. "Making money off kids with brain cancer? That's evil!" he says. "Do it by selling luxury cars or pornography." He compares it to Jesus chasing the moneychangers from the temple. You can make your profits—just don't do it here. "Not that I'm comparing myself to Jesus." Indeed, the email moniker on his business cards is "drdave666".
Ores draws a distinction between health "insurance" and health "care": he'd like to see a model based on the latter, which he figures would be "a hundred times less expensive" than the former. Under a true health care system, there's no gambling. It would be governed by an overarching, not-for-profit agency that would collect only enough money to pay out the costs to treat people's health. "Health insurance, as a construct," he said, "is unnecessary." His objection isn't the administration of health care, on which so many reformative legislative proposals are centered. It's the concept of health insurance itself.
"Find some other industry where someone gets in the middle," he challenged. There's no lawyer insurance, for example, no future protection in case you get divorced. (Imagine a lawyer, he suggestx, getting paid a small percentage to handle your divorce, while some middle man pockets the rest.) "They're way too smart for that," he says. "Doctors aren't geared that way. And when we weren't looking, they"—the insurance men—"came in and destroyed the business."
"It was once a profession, medicine," he added. "Now we're technocrats."
Not that Ores has much sympathy for his fellow doctors. "That's the other thing about health insurance: the doctors are in on it," he says. "The doctors are paid off." Many physicians are inured to the system, he says, and they make a lot of money off of it, too.
His favored solution to the health insurance quagmire, a National Health Service, doesn't have to be government, he notes. It could, for example, be administered by the Red Cross or another such non-profit organization. "That's probably better than government." Ideally, he'd like to see a National Health Service phased in over, say, 25 years. For example, you could raise the income level that qualifies families for Medicaid, or lower the age requirement for Medicare, gradually, year by year. "It'd be catastrophically disastrous to pass a sudden law," he says. "To be fair, people work for insurance companies."
In any case, a so-called public option would destroy the health insurance companies, he tells me with a hint of glee. And that's why they won't let it happen.
In the meantime, he continues to sling rocks at the health insurance Goliath with his small practice and his restaurant workers cooperative, in which roughly 25 restaurants are now participating. (He says he sees two or three restaurant workers a day.) He hopes the model will serve as a model for other doctors, as well; about three have already contacted him, from Florida to Long Island. He also hopes to have a website up and running soon, which will include a F.A.Q. on how doctors could set up such a cooperative on their own.
So far, I ask him, has the program been a success? Well, that depends on how you measure success. "If I saw one person in a year," he said, "it would be successful."