I conducted two economic transactions today:
- I bought some fruit
- I bought some medical care: the removal of a small lump from the inside of my cheek.
The fruit purchase followed all the rules of classical economics: I inspected the goods, decided if they met my needs, considered going to another supplier (we have at least six places to buy fruit within an easy walk, and they each have slightly different approaches to pricing and selection), and I could've dickered over the price if I'd wanted to. I understand fruit and my needs pretty well.
The medical purchase was nothing like this. I'm really not able to determine the medical necessity or otherwise of removing that lump. If I were dirt poor, I would have ignored it, but I'm not and I want to do what's the best in the long run. I'm not a doctor so I rely on the statements of others, but I don't want to go to a dozen doctors to get opinions; that's very expensive in money and time! So I trusted my medical professional and scheduled the minor operation, but I knew that I had no idea how much money I was committing. All the doc could say at the first meeting was that he couldn't say; when pressed, was sure that it wouldn't be a thousand dollars, but we knew it would be more than a hundred.
How in heck does anyone make a rational economic choice when you don't know the price except that it's between $100 and $1000?
Today I went in for the actual operation. Oddly enough, they knew what the price would be when I showed up, with the qualification that they could not promise how much the insurance would pay for, or how much the University of Washington would charge for a biopsy. The procedure was $495, and I don't know whether that includes the 1st visit or the followup. They estimated that the insurance company would pay about $147 and required that I pay the $348 before receiving treatment.
I don't blame them for wanting payment up front, but presenting the bill the minute before surgery, rather than at a time at which the patient can rationally calculate options, is inherently deceptive. I don't think the doctors are bad people but their organizations are set up so that patients cannot make economically rational decisions. At the moment, I'm dependent on the doctor for the followup visit so I'm not going to do anything, but once the course of treatment is over, I plan to have a friendly but frank discussion of how things went. There is no reason not to have a schedule of charges available, and the UW should be publicizing its biopsy charges as well.
I can't think of any other marketplace where we would buy something without knowing what it would cost!
I had a similar experience the last 2 times I went to doctors. I'd gone for a check-up and was told my blood pressure was too high; they wanted to start me on some medication or other. I did some research and found out about the DASH diet; the doctor agreed that some people found that useful, so I'm trying it - it's not an expensive diet and it's a heck of a lot cheaper than any medication ... not to mention that most medications have side effects I didn't want to risk.
I had been assured that periodic check-ups were important, and I'm covered by insurance, so I was pretty surprised to get a three-figure bill. The doctor's office assured me that this was normal and also that they had no way of predicting how much they would charge for a doctor's visit; it all depended on so many factors.
Another time I went to a doctor because I was having headings; they decided on a medical course of treatment that turned out to be completely inappropriate; rather than purchase the medicines I spent some time analyzing when I got headaches and (with Kris' help) figured out they were caused by dehydration and/or fatigue. Now that I drink water regularly, I get much fewer headaches, and those I do get are probably from fatigue, since they go away after a short nap ... every time!
Again, I don't think the doctors I consulted were bad people, but their organization does not seem well set up to deliver health effectively or economically rationally.
I don't know what can be done about this, but if I'm going to be hundreds of dollars poorer I want to learn something from the experience.
Sorry - no punchline or pretty picture from this one. Maybe next time!