Make Going to The Doctor More Like Going to the Vet

Earlier this year, our dog spent a few weeks in a lot of pain and on a lot of painkillers because a car hit her and broke her pelvis (she’s fine and has gotten back to dragging me all over our local park every day). Taking care of her made me wish going to the doctor or dentist was much more like going to the vet in one very important way: health insurance isn’t involved, so we’re pretty clear about our options and, importantly, how much those options will cost. When we go to the doctor or the dentist, the only price we face is the co-pay, and when we are talking about medical treatments, we don’t learn as much about the menu of options and the price of each. We got our dog fixed up with stitches and medication, paid for it all at once, and now have no additional bills, paperwork, or any unpleasant surprises from insurance companies we need to expect. 

No muss. No fuss. No complicated paperwork. No uncertainty. Taking the dog to the vet was more like taking the car to the shop than a doctor’s visit. We went in, they told us what our options would cost, and we chose. By contrast, I don’t have as much incentive to pay attention to costs when my only out-of-pocket expense is a small copay, and the insurance company handles the rest. What the insurance company paid for my visits to the optometrist and the sleep clinic are important parts of my actual compensation, though they don’t feel like it because they don’t show up in my checking account at any point. Would people get the sense that their real incomes were stagnating if they received their raises as salary rather than ever-more-expensive health benefits?

But isn’t healthcare a human right? The United Nations says it is–but declaring something a human right doesn’t change the fact that we cannot provide it without resources that we cannot use to produce something else. Of course, we can all think of ways other people waste their money on frivolous nonsense. Still, we might do well to look in the mirror and ask if we need to spend $1,000 on a flight, hotel, and meals to participate in a protest march in Washington, DC, because we think the government needs to provide something for “free.” When we say something should be “free,” that’s a shorthand way of saying “someone else should pay for it”–and eliminating prices does not eliminate costs. It only conceals them.

Moreover, the amount of health care people “need” depends on costs. Diabetics don’t have many substitutes for insulin, but hard cases make bad laws, and there are alternative treatments. For many other, more minor ailments, many different ways to treat them needn’t involve doctors’ visits or medication. For example, economist Bryan Caplan recently decided the trivial reduction in mortality risk from a tetanus booster wasn’t worth the pain and suffering from a needle stick and decided not to get one, which created a bit of unnecessary controversy on Twitter because there is a difference between thinking vaccines will hurt you and thinking a vaccine for a non-contagious disease that kills two Americans a year isn’t worth it. Earlier this week, one of my nieces got a splinter while visiting us. Did we call 911 and insist they prep an operating room for the extraction? No, we got out the tweezers. If someone else pays, it’s easier to “need” more health care.

“This is the price we pay for health equity and justice,” does not convince me. An ambulance transporting someone with a stomach ache (or a splinter) can’t transport someone else at that point in time. Ambulances require resources: when we say “yes” to another ambulance, we say “no” to another fire truck. The right choice is not clear with prices that make the trade-offs explicit.

Taking your dog to the vet shows how the market loves you–and your little dog, too. Life would be easier if going to the doctor were more like taking the dog to the vet.