Here’s what “free market medical choice” means to me in the USA right now:
I go to a medical insurance company ‘A’ and get a plan. The insurer is trying to control costs and I understand that, so they have limits on what they will cover. I agree to those terms, and I’m relatively happy with what I have on paper.
Now, I go to look for a provider. Some will take A’s insurance and some won’t. I finally find medical provider ‘B’ who will. Then I actually try to get treatment.
B does diagnostic work, for which they collect money from A.
Only after that… B refuses to treat my condition according to the limits of insurance company A, and forces me to sign a consent form allowing them to change the treatment to whatever B thinks is appropriate and, if A doesn’t cover it, to promise that I will pay.
I am disgusted, so I leave and seek provider C.
Same thing. More money drained. No treatment, unless I agree to the extortion.
Ditto. See provider D.
Same thing. Insurance from A runs out. No treatment is received at all, although the problem has been diagnosed three times.
Medical condition worsens. More expensive treatment is now needed to correct the problem.
Repeat again next year after insurance minimums are renewed.
On each occasion, I am strongly pressured to “just sign this ‘informed consent’ form”.
On each occasion, the documents the ‘informed consent’ form asks me to formally swear I have received and read are not given to me until I demand them. Sometimes they are on laminated sheets the provider refuses to make a copy of (on occasion, they ask for a fee for copying it). Sometimes, the provider’s agent holds the form in front of me, but resists letting me hold it or carefully read it.
Apparently (and the provider is often eager to convince me of this) most people just sign without reading (strongly implying I should do the same).
Clearly they don’t want legal proof of these actions to leak. Nor do they want patients to feel they have any choice. I would of course avoid these disreputable practices by choosing better providers — but I have never found one that didn’t engage in at least some of these practices.
On one occasion, I was asked by a medical receptionist to sign a form which warned me that the anesthesia used could cause death in some cases. There was no indication of the relative probability of this outcome, so of course it is impossible to make a rational judgment of whether the risk was warranted. I asked for information about this. It was refused.
Ultimately, I got into a shouting match simply because I wanted an ‘informed consent’ that actually gave sufficient information to make a rational choice. This was utterly pointless because the person I was speaking to was totally ignorant of statistics and probability and could not possibly figure out how to indicate evidence that the outcome was improbable.
Once again, I was pressured to sign “because everyone else does”.
I find these encounters terrifying and upsetting. I literally get the shakes when I visit medical professionals because of the constant need to assert rights, the constant taking advantage, and the constant power plays. It’s possible that I am simply weak on “people skills”, but I can’t be the only one.
One can also see the terrible pressure against rational behavior in our society (and in favor of herd behavior). We are constantly pressured and coerced to go along with whatever we are presented with — unless of course it comes up that it was wrong, and the provider can weasel out by claiming that I “freely chose” a procedure because of the “informed consent” form I have signed.
It is from this perspective that I turn a very skeptical ear to the right-wing Tea Partiers who are so vehemently against a public medical insurance system or a public health provider system. Their complaint is that it is “coercion”.
I’m sympathetic to that concern — but as I see it, “coercion” is something we have already. The only difference is who is doing the coercing. With a public option, at least there is some democratic oversight and we may bargain collectively. As it is, we are divided and we are conquered. And I am literally sick of this.