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Wed Jan 29, 2014, 06:49 PM

Thought experiment for "Free Market Healthcare"

I have one of those born on third base thinks he hit a triple libertarian friends, and he truly believes if all of us just paid out of pocket for health care costs, prices would go down. He likens it buying any old commodity, like buying a refrigerator. Anyways, I wrote him this vignette to reveal how absurd I think it is. Any comments or criticisms would be appreciated:

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Thought experiment:

Suzy gets sick has a seizure. We'll say in this universe that health insurance doesn't exist, it's purely out of pocket, because Emperor Dave wants society to work on free market rules, and make sure people like Suzy have "skin in the game".

So you go to the Emergency Department, because SUzy is now vomiting and seems kind of lethargic.

The Emergency Physician greets you and Suzy, performs a history and physical, and then says to you "Mr.Smith, I think Suzy might be having febrile seizures, but I cannot rule out an infection or even maybe a tumor. I have a couple of tests I think I need to run in order to figure this out. You need to tell me what I can order, so here is the price list"

1) Lumbar puncture: $3000
2) MRI: $5000

You say to doctor, hey, aren't theses prices a little high?

The Doc says, hey, these are the prices the hospital charges.

You say, I don't think Suzy needs a lumbar puncture. Can't we just get antibiotics and save some money?

Doc says, sir, if there is an infection, we need to know what the organism is in order to target it appropriately.

You: What's the evidence that a Lumbar Puncture is even necessary? And why do we need to do an MRI too?

Doc: Hey, this is based on the latest research. You have to trust me on this one. If we wait too long, Suzy might suffer serious neurological damage.

You: You know what, I'm going to shop around a little bit. And Emperor Dave is right, we consumers are smarter than these doctors, we can go on google and figure out what the best evidence based practices are!

Doc: OKay sir, there's another hospital down the street that you might be able to get cheaper care, but I'm pretty sure most of those docs get pretty bad reviews.

You: Fine, it's a free market, and if these guys offer a good price, it must be better.

You go to the "The Price is Right Emergnecy Dept" . The place is dirty, a little dingy, but this is the magic of the market at work here.
Suzy waits for a few hours, but you've gotta make sure you get a good price on this thing. She is getting sleepier but is still awake. You are dedicated to finding the best, cheapest care you can find.

The new doc says, hey what's up guys? Only have 5 minutes, based on what the nurse tells me, we should do a stat lumbar puncture and a CT scan.

You: Whoa, wait a minute, why do we need to do an LP? What does the research say?

Doc: Hey man, you gotta trust on this one. Here is the price list:
Lumbar puncture: $100
CT Scan: $1000

You: Wow, those are some great prices! How do you guys compete? Also, why CT scan instead of MRI

Doc: We get a lot of our supplies from Pakistan (those people work practically for free over there!) and the CT scanner we use instead of the MRI because it's a lot cheaper.

You: Any difference between the CT and MRI

Doc: Well, MRI does provide better views, but is more expensive you see. Gotta keep that magnet going 24-7! The CT scanner exposes you to radiation, but is definitely cheaper.

You: What are the dangers of the CT scan? Should I be concerned?

Doc: Here's a stack of medical literature you can review. Read it over and let me know what you want to do.

You: What? Are you kidding? That's what I pay you for!

Doc: Excuse me? Hey man, Emperor Dave only says we have to give the information, I can't spoonfeed it to you. I wouldn't wait too long because little Suzy's looking a litte tuckered out. What do you want to do?

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