The Free Agent Has an Ear Ache

What’s a Free Agent to do when she needs health care?

Being between engagements and insured only against disaster (she has the kind of insurance everyone used to have—the kind you hope you never have to use—not the kind that feels like a ticket for an all-you-can-eat buffet), The Free Agent has seen a side of American health care not often discussed—the kind you pay cash for.

Despite the impression one might get from the media that without medical insurance, an American’s only resort is infomercial books on home remedies, The Free Agent has paid cash for all manner of health care: doctor’s visits, prescriptions, routine screenings, even surgery.  But to imagine that the prices of these services are subject to market forces as we think of them is fanciful. Governments spend around 50% of every health care dollar in the US, with insurance companies spending a third.  Business and households spend the rest, mostly in the form of premiums and co-pays.  Blessed with the constitution of her peasant forebears, The Free Agent cannot consume enough health care to compete with third party payers.

So when she had an ear ache recently, The FA decided to visit Urgent Care  Manhattan.  (The Free Agent has a personal physician, Dr. Gulag, but seeing him ad hoc usually requires a long unpleasant wait.)  She arrived at 3:45 on a Friday afternoon to find a clean, quiet office where there didn’t happen to be a wait.  The basic fee is $150 ($50 less than Dr. Gulag charges—as another physician acquaintance said, “It used to be insured patients subsidized the uninsured, now it’s the other way around.”) with additional charges if lab work or further procedures are needed.  At 4:15, The Free Agent walked out the door with a prescription and aftercare instructions.

At that point, The Free Agent had the same treatment she would have gotten from Dr. Gulag, just more pleasant and convenient.  But two days after her visit, she got a follow-up call from a nurse at urgent care to check on her progress.  “You know if you don’t feel like you’re really getting better, call us and come in again, no additional charge.”  The Gulag staff, while amply compassionate, is far too enslaved by paperwork to make such calls.

Urgent care has been around a long time, and pay-for-service is making headway in other medical practices.  Direct Primary Care Medical Home (DPCMH) practices like Qliance offer health services at much lower cost, which they say is from saving the 40% a typical practice spends processing insurance claims.  For between $50-90 a month, clients get unlimited primary care and cell phone and email contact with their doctors, pre-existing conditions welcome.  The only thing Qliance will not do is process an insurance claim, but like Urgent Care Manhattan, they will provide information for the patient to submit.  About 50,000 Americans are in the care of DPCMH organizations.

In the final diagnosis, why had this experience been so pleasant?  The Free Agent wasn’t treated like a pilgrim to Lourdes, asking for a miracle.  Nor was she treated like a punctured tire, an annoyance that throws one’s already busy schedule further off.  What was that warm, valued sensation, even a soupçon of courtship, she felt?  The Free Agent had been treated like a customer.

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