Twenty-two years ago, I stumbled into the house after a day of teaching and when my wife asked what was wrong, I collapsed onto the bed and tearfully let go of concealing the intense abdominal pain that had been building all day. After a few days of diagnoses and testing, they used a scope to clip the end of my bile duct and remove a gall stone. They didn’t take out the call bladder. I’m not sure why, and boy, do I now wish they had.
Monday, now working from home, I called my wife and uttered “gall stones.”
“I’ll be there in ten minutes,” is all she said, and hung up the phone.
An eternity later, she got home and off we went to the ER. Having experienced this before, I knew exactly what this pain was. But this still was unexpected.
Fortunately, I’m part of a very large pool of employees as a professor in the MN State College system, so I have good health coverage. Or, at least good by today’s standards. It still costs me and my employer thousands to cover my family with a moderate deductible and maximum out of pocket cost, both of which are much higher and cost considerably more than when I first started teaching (a long time ago, we’ll say).
One aspect of debate in this country around health coverage is the control of the costs. I often will hear that free-market solutions can control costs if the patient is thought of as a consumer. From my experience as a consumer, so decidedly a one-sided perspective, I call B.S. There’s one ER in my town. When your spouse is doubled over in pain, you’re not going to shop for the most reasonably-priced ER. Then once in that ER, am I going to refuse their ultrasound service and go to another hospital or clinic to get an ultrasound? Once diagnosed, and assuming the pain has been managed, it isn’t really feasible at that point to shop for the most reasonable-priced surgeon and operating room facility. Again, that would require transporting to another town, plus most likely starting over with a new doctor from scratch after medical records have been transferred.
When in crisis, you are no longer a consumer. You are a patient. They are very different paradigms. The ER doctor and surgeon are not sales representatives, they are health care providers. At no point in my experience of walking into, being diagnosed, and initially treated in the ER, or the next day having surgery to remove the offending organ, was I ever treated like a “customer.” And I’m thankful that I wasn’t. I was a patient in distress and incapable of making a sound purchasing decision. At no point was the cost of anything discussed, or was I given a menu of levels of treatment for different costs. We’re not putting a new alternator in my car. We’re keeping me alive. I am extremely fortunate to have my wife as a personal ambulance service, access to health care and insurance, the means to pay the deductible and out of pocket maximum (though that’s a bit more shocking and painful–but less so than gall stones!) and the knowledge that my insurance will cover the rest of the cost. Therefore, in my situation, there was no hesitation about going to the ER. Many are not so fortunate.
Maybe some things are better left out of the free market, and even should be left out of capitalism entirely.
Now I’m regretting declining a copy of the ultrasound of my gall bladder and it’s warehouse of stones emailed to me. So, instead here’s my rendition based on what it felt like.