“How does your model work for the poor?”  “How does your free market deliver care to them?”  “What about the poor?”

These questions are some of the most frequent ones I encounter, invariably asked in an attempt to cast some aspersion on the idea that health care and a free market can coexist. Let’s break this down.

First, let’s begin with how I answer this question  

1)”Which poor?  Do you have some individual in mind?”  I answer in this way because health care is very individualized and also to better frame the context of the doubter’s original question. When asked about the “poor,” I refuse to answer in a way that addresses the aggregate of the “poor,” only individuals.  

Any aggregate answer to the issue of the “poor” automatically assumes the context of a “systems” answer, one which deteriorates quickly into the collectivist’s trap where confiscated funds find their home.  An aggregate answer also tacitly rejects the idea and doctrine of subsidiarity, inviting central planners from far away to offer their “solutions.” Addressing poor individuals as individuals removes them from the gunsights of collectivist “do-gooders” who would ruin their lives with their various “programs” or “answers.”

2)”If you are asking me what my intentions are with regard to the care for the poor, I will be happy to tell you mine after you tell me yours.”  “Surely you don’t mean that I should bear the entire financial burden for the poor, do you?”

This answer makes obvious whether the person claiming to advocate for the poor is willing to do so with their own money or only that of others.  For my part, I can easily demonstrate that many of the poor patients having surgery here do so due to the affordable prices (less than what Medicaid pays the hospitals many times) here in sharp contrast to the price at the “not for profit” hospital down the street.  The answer above challenges the free market skeptic to personally embrace a charitable position rather than advocate the robbery of the state.

A less obvious reason to refuse to supply an aggregate answer to the question about the “poor” is this:  an aggregate answer will only make sense if the savings (to all of those who have their surgery at my facility who therefore financially benefit from our pricing) are taken in to account.  This is a twist and merely another example of Bastiat’s “what is not seen.” What follows explains this clearly, I think.

I recently helped a patient from the northwest arrange a surgery here in Oklahoma City (not at our facility it turns out) for $9150, a procedure for which her closest second quote was $90,000.  While $9150 is a lot of money, by any stretch of the imagination she saved $80,000.  And while a $90,000 charge for her procedure is entirely fictional and meant to pad a hospital’s uncompensated care balance sheet, her savings is real, however fictional the process of arriving at $90,000.  The aggregate financial burden of caring for the poor cannot be considered without also simultaneously considering the aggregate “savings” that our free market approach provides.  After all, the needs of the poor could be substantially met should this patient have made the decision to be charitable with but a portion of her savings ($80,000).

While we are doing our part to keep costs down, promote healthy competition and deliver high quality and affordable care, the collectivists continue to play their broken record:  robbing some for the benefit of others.  Masquerading as advocates for the poor becomes more difficult for the statists if their question,” what about the poor?” is placed in proper context, I think.

G. Keith Smith, M.D.