Here’s a story about how our current health care system does not really resemble a free market.
I had never gone to a gynecologist’s office. This is not surprising, but apparently once you become a Dad-To-Be, this is one of the things you do. It’s also one of the things you do at least once when you’re [planning/contemplating/fighting tooth-and-nail over] home birth, because midwives are apparently all “concerned for your child’s health” and want you to “see a doctor at least once.”
How do you find a doctor? This is probably worth a separate post all to itself, but suffice it to say: we don’t know. Normally the midwives recommend that you go to one of the few doctors still ballsy enough to agree to be a backup physician for a home birth. Unfortunately, none of those guys take our insurance. And for complicated reasons, we may not be pursuing a home birth anymore anyway. So Elana went through all the lady-parts doctors in the L.A. area who took our insurance, narrowed them down to the ones who didn’t seem like their primary motive for being OB/GYNs was an academic interest in “Cervical Tumors” or “Abnormal Vaginal Bleeding,” and created a “short list” of possible candidates. Among these, Dr. Arjang Naim had the silliest and most charming website (I encourage you to visit and check out his prom picture!), so we went with him.
So, then — the sequence of events at the doctor’s office:
- Come inside. Look around. Fill out paperwork while wife goes to bathroom.
- Hand over insurance card. Try to determine who, exactly, is meant by “The Insured.” Insurance card is photocopied and returned to you.
- Meet with the nurse, who asks you the same questions that were on the form you filled out earlier. Maybe she’s trying to catch you in a lie.
- Meet with the doctor. He will be confused about why you only want to see him once.
- The doctor will ask if you want an ultrasound. Everybody has an ultrasound, and it’s supposed to be a very meaningful experience, so you will say yes.
- Doc reaches over and picks up a little handheld scanner connected to a crappy black-and-white TV, sticks it on your wife’s belly. Gray blobs grow and contract and vanish and reappear like a particularly dull screensaver. You are underwhelmed. Your wife is underwhelmed. Your baby, meanwhile, apparently has a spine and a normal-sized cranium.
- The sawbones finishes up his exam and tells you you can leave.
- You go to the lobby and stand around, waiting for someone to ask you to settle up. No one does.
- Minutes go by. Other mothers (no dads — apparently not everybody’s dad is a graveyard shift hobo) fill all the chairs, so you stand awkwardly under the TV that runs women’s health ads all day and is currently trying to tell you about the best positions for sex during pregnancy.
- Your wife, unable to stand it anymore, finally asks the stern Persian lady behind the desk if she validates parking. She doesn’t.
- You leave. On your way back to the car, you realize you have no idea how much all that just cost.
And this is the glory of our non-capitalist, non-socialist system, in which all decisions about care are made in a financial vacuum. We don’t know, even now, how much that visit cost, how much our insurer was charged, what size bill we can expect to receive, whether the worthless ultrasound cost extra or was included in the bill. We also don’t know, given that it’s August and that we have a $300-per-financial-year deductible, whether we would have gotten a better deal if we had just not bothered giving them our insurance card and instead negotiated a flat out-of-pocket fee.
No one gives you a bill when you leave the office, which I suppose is okay, since no one asks you for money, either. It’s taboo to talk about money in a doctor’s office, I suppose, which is strange for the kind of place that has a billing department. I mean, I understand the social awkwardness about money when it comes to certain sacred professions. My college called my student loans “financial aid” and liked to act like the quad was basically a philosopher’s grove where any curious traveler could seek enlightenment. But they still had an office with windows and teller drawers and accountants who would tell you how much you owed.
There’s something very strange about this for what is supposed to be a capitalist transaction. I mean, imagine if other stuff worked like this. You go to the supermarket, and there are no prices anywhere. And then at the end you just walk out.
“Do we have to pay for this?”
“Oh, we’ll bill your fruit insurance company, and they’ll send you a statement.”
So, in case it ends up costing us $60,000 and an act of prostitution, here’s a printout from that ultrasound. It apparently indicates that we’re going to be raising a blotchy gray triangle.