I have found that after I have spoken to a group about our free market surgery center, the same question pops up.  Every time.  Someone will always ask how our model applies to the poor and indigent and how many of those folks do we take care of, after all?  

I’ve answered this in various ways.  Before I deal with it here, it might be useful to delve into the assumptions that the questioners have perhaps made.  Almost all who have asked this question have fallen for the big hospital lie, that “they take everyone who comes through the door.”  Believe me, I know that they don’t, as we see a lot of folks at our place that have been told “we can’t help you,” from one of the big hospitals, for one reason or another, usually money, but not always. Other questioners are employing an intellectual straw man.  Somehow in their minds, if our model doesn’t perfectly apply to all people at all times, then it has no use, or is so flawed that it merits no further consideration.  Others, in a variant of the first hospital lie, have determined that we are “cherry picking,” selecting out only the healthiest patients, only those who can pay, and after all, who couldn’t be successful doing that?!  Others are unable to grant any credibility to a health care professional who doesn’t spew the same lies about charity care that the big boys in suits spew.  The whole time I’m talking about prices that are a tenth of what the so-called “not for profit” hospitals charge, the whole time I’m talking about rescuing Canadian patients waiting in long lines, the whole time I’m talking about our price having spared a young family a bankruptcy proceeding, this last group of folks is wringing their hands, thinking, “…he hasn’t mentioned indigent care one time.”

There are probably more reasons for this question than I have listed.  My frustration with this question is with myself, however, as I have inadequately answered it in the past.  I have taken the bait and attempted in every instance to answer the question on the questioner’s terms.  I now know that this has been wrong.  I’ll try to answer the question in a better way.

Yesterday, we operated on a patient from Idaho.  He had no insurance. He was quoted $11,000 for his surgery.  We did the whole thing for $3740, the price advertised on our website-everything included.  I did his anesthetic and it occurred to me during the case that when I interviewed him there was one question he didn’t ask me.  That’s right.  He didn’t once ask about how our model worked for the indigent, those who couldn’t come up with the fee listed on our website.  For his family, in his own personal world, he was saved a little over $6000, if you include travel and lodging costs.  That’s all he cared about.  

I have never been asked “how does your model take care of the indigent,” by one single patient whom we spared bankruptcy with our fees.  Not once.  That our fees are charitable when compared to those at the big hospitals seems to escape the attention of the detractors, those who can’t stand the idea that cheaper and better are possible without government involvement.  

I have come up with my answer.  In the future, I will say in response to “the question” the following:  

The money I save patients, the difference between what patients pay us compared to their next best alternative, is money that can be used by these patients to better care for the indigent, enabling their charitable power, if you will.  While this is a sufficient answer to your question, I’ll go further.  We will continue to appropriately provide true charity care, unlike the hospitals who while waving their charity flag with one hand, accept their uncompensated care payments from taxpayers with the other.  Hospitals provide no indigent care if you follow this logic.  

There is nothing preventing folks who ask the “question” from setting up a foundation with money they have saved from using our facility, to help pay for rationally-priced care at our facility for the needy.  Or are we meant to absorb the entirety of the charitable burden?  The patient I mentioned above could have purchased two more knee surgeries for the needy with the money he saved by coming to our facility, if he so chose.  Government has another method, don’t they?

“Deafness foundations” have found that they can provide three cochlear implants at our facility for the price of one at the “not for profit” hospital across town. You could say we had a “buy one and get two free” if you actually looked at the hard dollars!   I doubt that this fact would have much of an effect on those who ask the “question” as they simply cannot imagine the provision of medical care without the involvement of the state. 

G. Keith Smith, M.D.