Yesterday, as staff at two different Arizona veterinary practices in cities many miles apart patiently explained to me the options for treating my snake-bit dog and the likely menu of costs for doing so, it occurred to me that I've rarely been treated with so much respect for my decision-making abilities or my wallet in any medical office geared toward two-legged customers. The reason is simple: At the vet's office, I'm the ultimate decision-maker and the payer-of-all-bills. At my doctor's office, I've allowed myself to be pushed to a secondary position as a responsible party. And the difference shows.
With my dog, Max's, head swollen like a pumpkin, I was presented by his usual veterinarian in Sedona with a couple of treatment options and the likely total costs ahead of time — including the stiff tariff for antivenin. I went for the "save the fuzzy bastard's ass" option, and paid.
After antivenin and other treatment, Max needed to be watched and medicated, so typically indulgent dog owner that I am, off I drove to Flagstaff to a facility that offers 24-hour care. There, not only was I presented with an estimate of the likely low and high costs associated with his care, but the prices of common procedures and vaccines were posted on the wall in every room.
My wife, a pediatrician, doesn't post price lists. They're irrelevant, since very few of her patients pay their own bills. Even regular, predictable expenses are handled by insurance companies, or by government programs, or by convoluted combinations of the two. She loves kids and respects parents and discusses care with them. But many of the important decisions are made elsewhere. There's little point in going in-depth about possible medications with a Medicaid patient when you're going to end up playing whack-a-mole with the AHCCCS Formulary — the ever-morphing list of medicines that Arizona's implementation of Medicaid has decided to pay for this time around.
The idea of removing patients as responsible parties was to remove money from the decision-making process — to give us the illusion that care is free, and that treatment will be provided with no need for us to fret over the bills. It's not free of course. We've just bought the illusion, and transferred the cost-benefit analyses to somebody else. We still get some choices, but unless we're among the few who pay out of pocket, they've been winnowed and pre-approved ahead of time.
Actually, there is one place where people make real choices: The dentist. After a day of not discussing costs with her patients, my wife has been known to decide among a few tough alternatives at our dentist's office for treatment of her inherited slow-moving train wreck of a set of choppers. But, like veterinarians, dentists expect most of their patients to pay their own bills.
Yes, there are some costs that are beyond the means of many people, and there are resulting tradeoffs to be made. But if we want to get the same adult choices in a doctor's office as we do at an animal hospital, we have to take back more of the responsibility for, at least, the predictable costs of our own care.