With most market goods, the seller is supposed to maximize his profit. You may have good reasons not to try to fleece your customers, but if you're selling cars, you have every reason to steer them toward the more expensive (or, at least, more profitable) model. The traditional basis of medicine is not based on the market for very sound reasons. Doctors have a massive information imbalance over patients. That's why we don't set them up as parties to a financial transaction. The doctor is a kind of secular clergy presumed to be acting in a way synonymous with the patient's interest.This is a situation that I am all too personally familiar with. My wife has successfully battled cancer twice in her life (leukemia, then breast cancer) and is a regular patient at Houston's excellent M.D. Anderson Cancer Center. For a patient with her history, doctors have a need to be extra-cautious, so just about any complaint is justification for an expensive battery of tests. On her most recent visit, she complained of frequent headaches (acute sinusitis is another curse that she has lived with for years) so her doctor (actually a nurse practitioner who works for her oncologist) ordered a full-body MRI, a test that typically runs in the vicinity of several thousand dollars. She is lucky enough to have extensive insurance via her employer (a major university) but even then we determined that our out-of-pocket cost for the procedure would be prohibitively high. Previously, we had the option of shopping around for a cheaper MRI provider- there are any number of hospitals and private surgical centers that have these machines. Not this time, said the nurse, the hospital wants you to have it done here, and we won't take anyone else's tests.
Which now puts us in a bind. The nurse practitioner and oncologist clearly think this is a necessary test for her to rule out any new cancers, but we simply do not have the cash to afford it right now (we waived bye-bye to our credit long ago... cancer, even with insurance, is insanely expensive) and are not allowed to even explore the option of getting it somewhere else for less. So we really have no options: no scan will be done (for now).
Now, I admit that I resent the hospital somewhat for putting me in this position. On the surface, I feel like I'm being fleeced- aren't there other, cheaper tests that could be done? Why was cost not a factor in this decision? Do they expect me to sell my car or rob a bank so that my wife can have her scan done sooner rather than later?
No, the truth is, nobody is getting fleeced here. This is the best, most comprehensive test available, and I personally believe that no effort should be spared if it means possibly catching another cancer early enough to treat. The doctor is doing exactly what I want her to do- take whatever steps are necessary to keep my wife well. The fact that MRI machines and the techs to run them are expensive, that even good insurance isn't ever going to be good enough (as an actuarial liability to the insurance company, my wife is like a black hole down from which no money escapes), are not factors that her doctors consider when making purely medical decisions- and that's the way it should be. I don't want her doctor to have the attitude that medicine needs to take a back seat to considerations of the lightness of my wallet.
The only question is, are we better off as a society when we leave it to individuals to shoulder all of the financial burden of the right attitude in making medical decisions?
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