How Much Do You Want to Pay for Medical Care?

by John Goodman,

Suppose you could magically pay any fee you want to health care providers and they can’t refuse. You can’t control the fee others are paying. But you can select your own. What fee would you choose?

Your first inclination might be to select a fee of zero, or at least something close to it. So let’s try that out in a thought experiment. When you call for a doctor’s appointment, you would discover increasing difficulty getting one. You would be put on hold for long periods of time. The number you are asked to call might be answered by a voice recorder, not a real person. When you are given an appointment, it would be weeks (perhaps months) away. When you arrive at the doctor’s office you would discover that others in the waiting room are seen before you are ― even patients who arrive after you have arrived.

BTW, I’m not making any of this up. I’m more or less describing the difference in how patients are treated by dermatologists if they need a Medicare-covered service versus a service for which payment will be out of pocket; how Medicaid patients are treated vis-à-vis non-Medicaid patients; and how I have observed that HMO patients are treated versus patients who pay market prices.

Choosing a fee below the fee everyone else is paying means you will be the least desirable patient to doctors from a financial point of view. It means you will be the last patient doctors will want to see. It doesn’t mean you will never get care. It means you are likely to be the last to get care.

So let’s consider a completely different choice. What if you choose to pay a fee higher than everyone else is paying? In that case, you are more likely to get a same-day or next-day appointment. If there are patients in a room waiting to be seen, you are likely to be one of the first. Indeed, the doctor may even call you and talk to you about your health needs on a phone. She may email you. This is why (surprise!) given the opportunity to pay any fee you choose, you might actually volunteer to pay more than what others are paying.

Again, I’m not making any of this up. This is precisely what “concierge care” is all about. People pay more to concierge doctors so that they can get more care and better care.

Now if you are inclined to think this is all fanciful, you are completely wrong. What I have just described (in less than 500 words) summarizes the principal difference in how the left and the right think about health care. It also describes the principal difference in what the left and the right expects to happen under ObamaCare.

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