Health care is not a free market

A few years ago, I ran the Marine Corp Marathon. It was not a brag-worthy performance, but I finished and that’s all I really have to say about it. I’ve checked it off the bucket list and I’ll probably never go that long of a distance without the assistance of a car ever again.

In the weeks after, I developed a pain in my hip. I went to my primary care doctor who couldn’t figure out what was wrong. Concerned I could have torn something, the doctor referred me to a specialist who recommended an MRI.

I had a terrible insurance plan with a ridiculously high deductible compared to my salary. When I called to make the appointment, the receptionist told me I would need to have the payment for the MRI at the time of service.

“How much will that cost?” I asked.

“We don’t know,” she replied.

“What do you mean you don’t know? You don’t know how much you charge? How much money should I bring?”

“Well, it depends on your insurance. You can look up an estimate on your plan’s website,” she told me.

I went to the website. It came up with an estimate of somewhere between $600 and $1000. Oh, that helps a lot. At the time—this was basically telling me I would have to bring one of my paychecks to pay for this MRI. It was incredibly frustrating as I was in tremendous pain, but following the newsroom furloughs of 2009, I simply didn’t have that large an amount of money sitting around anymore.

There are certainly people who have much more dramatic stories involving much more life-threatening circumstances than this. But, I use this story to illustrate a point: Health care is NOT a free market activity. It is a basic human right.

There were only two specialists in the place where I was living. Only one took my insurance. There was no way to comparison shop before selecting the best doctor for the best price. I couldn’t even get a price!

Few people comparative shop their doctor by price. They pick the person they have the best relationship with who is covered by their insurance. And certainly, in an emergency, nobody is saying in the back of the ambulance, “Excuse me—before you take me to the ER could we please call and find out what it might cost?”

And let’s be honest, you can only comparative shop if you have the luxury of time to do so. Check out this video by Vox about what happened when one guy tried to comparison shop for the birth of a baby.

You also can only do this sort of comparison shopping if you have the luxury of living in a community with multiple options for doctors. If you live in a rural community, you likely have the option for only one doctor and one hospital. And those hospitals are struggling to keep their doors open because it is not profitable to operate in smaller communities with fewer patients.

Yet, in the aftermath of this week’s AHCA vote,  I keep hearing people say “Yeah, it is sad that people aren’t covered if they get sick. It’s terrible. But I’m a free market person.”

I feel like they do this so they can try to claim a fictitious moral high ground of supporting an American value of “free markets” while washing their hands of the morally bankrupt decision to deny health care to those in need.  Put money in your HSA! Take control of your health care! Live a healthy life!

They will also say you can comparative shop when you purchase your insurance. That’s not true either. At last estimate, around 12.2 million  Americans were enrolled in insurance through the Obamacare exchange during the 2017 enrollment period and were, thus, able to choose their own plan. However, most Americans get their insurance through their employer and have no say in the cost or type of coverage they receive.

So, the next time a person tells you that health care is a free market activity, ask them this:

  • When is the last time they checked the prices at their doctor’s office?
  • When is the last time they comparison shopped for a doctor or prescription based on price?
  • When is the last time they comparison shopped for a hospital in an emergency?
  • When is the last time they comparison shopped for insurance and how do they know that will provide the best coverage at the lowest price?
  • If they say yes, what services did they price and how did they know those would be the only ones they would need?
  • If your family member was in need, would you choose a doctor based on price alone?

Most likely the answer to these questions are “I didn’t,” “I don’t” or “No.”

That’s because  health care is not a free market activity. It is a basic human right. Receiving care when you are sick is a matter of human dignity. It is not a competitive marketplace where you can accurately anticipate your needs and buy a product to fit those needs. You have no idea what biology might hit you with, so it is hard to anticipate what to price and what coverage you may need.

Health care cannot be compared to other types of insurance because there is no choice involved. I’m so tired of the “car insurance” comparison. You do not choose your lot in life like you choose how you drive or what car you have insured. You can choose not to drive. In fact, even in car insurance, states mandate what type of coverage you need to make sure you are covered if an accident should happen.

Standards for coverage was something Obamacare mandated to make sure people weren’t getting swindled by a low-cost plan that didn’t cover anything. Now, that provision is in jeopardy.

I don’t know when our country got so mean toward one another and so hostile to the vulnerable. I don’t mind paying a little more in taxes to make sure rural Kansas has a hospital for our farmers or that a sick child can have access to a doctor. I don’t know when we decided to prioritize the “free market” over the dignity of our fellow Americans.

Then again, I’m more of a “But for the grace of God” person.

If you are as well, spend this week calling your Senator. Donate to those challenging the House members who voted for the bill. Sign up to volunteer with a campaign or cause.

And finally, just look out for one another. There are a lot of people tremendously worried about what this might mean for themselves or their families. Make sure they know they are not alone and that people are fighting for them.

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