It was the classic slip-n-crunch. I stepped onto wet tile in my bare feet and the next thing I knew, I was dancing an impromptu salsa that ended with a thud on my wrist. Ouch! I’m usually a wait and see kind of person when it comes to medical care, but this felt like a break. I don’t have a regular physician here (I live part-time in two different states), so I thought about going to the local emergency room to get it x-rayed, but ERs are designed for major trauma and I was just nursing a sore wrist. I didn’t need Shostakovich when the neighborhood piano teacher would do. So I asked the ER receptionist if there was a walk-in clinic in the area. She told me about a clinic in Yonkers and gave me the phone number and address. Good for me, I thought. I’ll save money and time.
At the walk-in clinic I asked how much the visit would cost me. (I have a high deductible that wouldn’t kick in for something like this.) "That depends on your income," the receptionist replied.
"Let’s just assume I’ll be paying the full amount," I told her. "How much will it be?"
"I don’t know," she insisted. "It all depends on your income." I looked around and realized that I was in a welfare clinic. All I wanted was a private ambulatory urgent care center, the kind where you can go for minor illnesses and injuries without needing an appointment.
The answer to my next question was just as discouraging: "How long will it take to have it x-rayed?"
She looked at the clock. "First you have to see a doctor. And Radiology closes at 12:30." It was already noon. I gave up on the x-ray, bought a soft cast from the drug store, and immobilized the wrist myself.
A few days later I was lamenting the lack of non-welfare walk-in clinics in our county. My friend told me about one near her home. My wrist was still hurting, so I went to the urgent care center she recommended.
There I was greeted by a smiling receptionist who took my information and offered me a seat. Ten minutes later I was ushered into an examining room, where I hadn’t even opened a magazine before the nurse practitioner walked in, examined my wrist, and sent me to the Radiology Center down the hall. Although it was a separate business, I didn’t have to fill out additional forms; all of that was handled by computer. Ten minutes later I was back at the clinic, and five minutes after that the N.P. was giving me instructions for treatment and sending me on my way. Total time? Less than one hour.
I’m a big fan of nurse practitioners and physicians’ assistants. They are highly trained professionals who can do just about everything a medical doctor will do during an initial visit. They can diagnose illnesses, treat simple fractures, suture wounds, and prescribe antibiotics. They work closely with large medical practices and can refer a patient quickly to a doctor or hospital in case of serious illness or injury, often securing an appointment faster than the patient could do alone.
Nurse practitioners and physicians assistants usually spend more time with the patient, and they charge less. One N.P. I know charges a flat $25 per visit, and she schedules a full half hour for each patient so she can spend some time talking about lifestyle and nutrition. She doesn’t take insurance, but who needs to file with an insurance company when the total charge is barely more than a co-pay would be?
Medical care is one of two services I know of where we are expected to buy without asking the price. (The other is a funeral.) Our third-party payer system is the primary reason that health care costs continue to skyrocket. Increasing the variety and availability of health care by encouraging the expansion of alternative providers will do more to reduce the cost than any government program.
We haven’t had a free market in health care for over a hundred years. We have to get government out of the way and let a true free market do what it does best: increase the quantity, quality and availability of goods and services. A combination of high-deductible insurance to pay for catastrophic illnesses and injuries coupled with Health Savings Accounts to pay for day-to-day expenses is the best way to achieve the best health care for the most people at the lowest cost.
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