I want to talk to the people out there who think the free market is the answer to our healthcare crisis.
But first: what is the free market? Well, generally, it’s a transparent and competitive marketplace where a willing buyer and willing seller can engage in an informed transaction. Sounds just like buying a cell phone, a car, even a house, maybe braces for my kids’ teeth. But healthcare? Be serious!
I’d like to look at this through my eyes. I’ve always had insurance, mostly employer-provided, gold-standard kind of stuff. I’m a lawyer with an economics degree and married to another lawyer. So let’s be honest, statistically, maybe 2% or 3%, of the population are specifically in our healthcare shoes. (Cue the violins.)
Back in Chicago, these two lawyers were super-healthy, going about their lives. There was this insurance policy they knew little about. My wife decided, as an early healthcare pioneer might, that she wanted Lasik. Cool. Let’s power up Google and see how much it costs and what kind of reviews the different providers get on Yelp. Oh, wait, it’s new. There’s just one provider. And it costs whatever he says it does. And it’s not covered by insurance. And the Internet hasn’t been invented yet, so there is no online research and there are no Yelp reviews.
Me, I’m a road biker. I loved to ride my bike up and down Lake Michigan. Did you know it is very flat along Lake Michigan? Well, someday I figure I might have a bike accident, so I researched Chicago hospitals to figure out: if I’m riding on Lake Michigan and have a bike accident, where will I want to go? No, of course I don’t do that.
Then one day I’m in Utah building my dream house and riding away from the construction site at 50mph. Only it’s not flat. I’m on a hill. A really, really big hill. My front tire came loose and I remember thinking, this is going to hurt. So after the fire department scraped what was left of me off of Wasatch Boulevard, I woke up at the Alta View Hospital, in and out of consciousness, several procedures gone by, doctors and nurses galore. Lots of good that research I didn’t actually do did me. There was no discussion about what will be covered or not covered. There was no research about the cost of an MRI or a CT scan. There was no research about the plastic surgeon who will try to restore my skin that right then looked more like hamburger meat than human skin. There was saving my life and providing me the best care the facility and its doctors and employees could provide. I separate those two, not to elevate the stature of the doctors, but because they probably are not employees of the hospital. Right now, they work directly for me.
I’m also a skier and since I apparently like to get really hurt every 15 years or so, I was out for a nice ski day at Snowbird a few years back with one of my kids and some friends when one of my skis caught on something, and I went flying. If you’re a skier, you know that we’ve all done this. Multiple times. But this time it’s different. I heard my leg snap as I cartwheel through the air. By the time I landed and ski patrol came to my rescue, I had five broken bones. (Oops.) So off we went to the Snowbird Clinic (terrific, by the way!) and then, after getting me stabilized, they sent me down to Alta View (my old hospital stomping ground!). While I was probably high as a kite, they didn’t ask me if I prefered Uber or Lyft. Nope – they called Gold Cross Ambulance who, because, you know, it’s a free market, charged me $1,500 to drive the non-emergency 10 miles from Snowbird to Alta View.
Now I’m pretty sure Alta View sees its share of patients from Alta and Snowbird, so I was not thinking about researching the best hospital for my bone repair surgery when in comes the doctor who is on call who explained what he thought we should do. It involved a fairly graphic description of some screws, a metal rod, and tools that sounded like I could get them at Home Depot down the street rather than here in the hospital. (Surely they’d be cheaper at Home Depot.) So my lawyer wife and I say hold on, let’s see whether we can get a rod put into my tibia and four screws on Amazon Prime – hell, I can wait two days! But no, no such surgery is offered on Amazon Prime so we tell the doctor to go ahead.
Along the way, ridiculous premiums were paid on my behalf. No one told me what anything would cost. (Those screws were almost $1,000 each when I finally see them on the bill; and when they come out, I can’t even resell them to someone else on eBay!) I didn’t know who was in-network or out-of-network. I didn’t know who my insurance company negotiated with or what they would cover and if I’d be left with a balance or not. I was dealing with the hospital, my surgeon, my anesthesiologist. Oh, and the ambulance company.
And this is my experience in the healthcare free market. Did I mention that this was all before Obamacare? Me – I’m hugely annoyed. I have bills I don’t understand, hours get sunk into trying to figure out if I owe people money or not. Hundreds, maybe thousands of dollars out of pocket. And there was no way I was paying $1,500 for that ambulance ride! But I didn’t lose my job. I didn’t go broke. I didn’t declare medical bankruptcy. I didn’t have to choose between paying these bills or paying the rent or feeding my kids.
So if you want to have a discussion about fixing the healthcare system, let’s do it. But if you are one of those who believe the free market is the solution to our healthcare problems, please explain where I went wrong with my economics and law degrees. And you better come at me with more than your tattered copy of Atlas Shrugged.