Once again, my life has conspired to give me a real-world example of how consumer-driven healthcare saves money.
At five o'clock on a sunny spring Friday afternoon, my six-year-old begged me to go outside and ride Razor scooters. We went to the top of our enormous hill (wearing helmets and biking gloves, or course) and came speeding down again. Right at the end of the ride, as I was stepping on the brakes to come to a stop, I found the scooter wasn't slowing down. I pressed down harder, and suddenly the whole scooter kicked out from under me to the side. I flopped sidewise and landed smack on the pavement. I sat up, feeling a little stunned but not too bad. "Am I hurt?" I ask Malcolm. "You're bleeding!" he shouts. I looked down and saw quarter-size drops of blood on my jeans and gloves. I walked about twenty yards into the house and look in the bathroom mirror. My left cheek is covered with blood. After gently wiping it away, though, I find I have only one injury: a cut under my left eye, about an inch long. Later on I figured out that the cut had come from the edge of my rimless glasses.
I wrapped ice in a wet washcloth and held it on my face while I contemplated what to do. My wife Janet, juggling an infant and two other sons, called a neighbor to drive me into the emergency room. I briefly considered going to an urgent care clinic, but at that point I wasn't quite sure what I was going to need. I figured I'd be better off going to the emergency room, in case the cut called for a plastic surgeon.
I sat for three hours in various waiting rooms at UNC Hospital, ice clutched to my face. After the first two hours I decided that I wasn't concussed and hadn't broken anything, and I started to wonder if I'd made the right decision to come here. After a few text messages to my wife, I found out I didn't have any other option; all the urgent care clinics closed at 8 pm. I paged my regular physician, who advised me to stay put; "Since it's your face, you're probably in the best possible place." Ok. Fine.
After another hour in the examining room, the doctor finally arrived: a young, calm, conscientious resident. I had had lots of time to prepare my speech. "Hi!" I said. "I'm really, really glad to see you. Before we get started, though, I have one small request. I have a high-deductible insurance plan. That means everything you do for me tonight, I will be paying for entirely out-of-pocket. So, as you do your work, I would appreciate it if you tell me what services I can expect to be billed for, and what they might cost, if you know." The doctor was very sympathetic: "To be honest, I know absolutely nothing about what you will be charged. I just write down what I do, and someone else figures out the charges. But I will keep that in mind as we discuss your options for treatment."
I was very glad we started with that conversation, because here's what the doctor said next after examining me: "Because you have a laceration on your face, ordinarily we would call in the 'face team,' which would include a plastic surgeon as well as an experienced EMD. However, looking at that cut, I can tell it's really clean and would come together with just two or three sutures. I could do that for you right now."
"In your professional opinion," I asked, "How much difference would there be between you doing the stitching, and what the 'face team' would do?"
The doctor shrugged. "Not much . . . none, really."
"Ok, then! Stitch me up!" It only took about 20 minutes for him to do the job. There was no mirror in the examining room, but he led me to a bathroom around the corner so I could look at his work. As promised, the wound was closed completely, with three sutures. A nurse gave me a tentanus shot and I walked out, a satisfied customer.
What are the morals of this story?
Always wear a helmet when you're on wheels. I wasn't going fast, I wasn't doing anything daring. I just fell, and that was enough to seriously mess me up if I wasn't wearing the right safety equipment.
Healthcare costs go down when consumers have an incentive to spend wisely. Were I covered by Obamacare-mandated insurance, I would have said, "Sure! Bring in the face team? Why not? I've already paid my deductible." But because I was spending my own money, I asked more questions about treatment options and probably saved $1,000. (I paid $190 for my treatment that night.)
Conversely, healthcare costs will continue to rise as long as patients and doctors have no incentives to contain costs. My ER doctor had no idea what his actions were costing . . . is it any wonder that costs are high? Nor would he make any effort to economize, unless I (the patient) ask him. This is why healthcare costs are rising – it's not the uninsured, not technology, not evil pharmaceutical or insurance companies. This is why I oppose the Democrats' healthcare bill: the one proven means of controlling healthcare costs (consumer-driven HSAs) will be rendered illegal under the new legislation, while the greatest cause of rising costs (disconnecting patients and doctors from the financial consequences of their decisions) will be mandated for all.
I keep ping-ponging between you and my mother. Both of you make very good arguments on both sides of this issue.
My mother lived in England for a year in the 1960s, and she is very convinced that the socialized medicine worked great. Standard, run-of-the-mill care was free and very good. If you wanted more than that, you paid through the nose. Costs were contained and no one went untreated for financial reasons.
I recently discovered your site and have spent the last several weeks reading one or two of your past posts each day during my lunch break(I am a teacher). I just wanted to say thank you for your writing. Every post is not only enjoyable to read, but also thought-provoking. I would have sent this in an email instead of a public comment, but couldn't find a link. In specific regard to healthcare, I agree with most of your ideas. I recently switched to a high deductible program myself, and have had similar experiences to the one you describe here. I do think, however, that NFL commisioner Roger Goodell's recent quote in regards to the overtime workings is applicable to the Obama plan: "Don't let perfect get in the way of better."