Competition Works, Even in Health Care

Capitalism is the best. It’s free enterprise. Barter. Gimbels, if I get really rank with the clerk, ‘Well I don’t like this’, how I can resolve it? If it really gets ridiculous, I go, ‘Frig it, man, I walk.’ What can this guy do at Gimbels, even if he was the president of Gimbels? He can always reject me from that store, but I can always go to Macy’s. He can’t really hurt me. Communism is like one big phone company. Government control, man. And if I get too rank with that phone company, where can I go? I’ll end up like a schmuck with a dixie cup on a thread.

LENNY BRUCE

This is the opening quote of one of my favorite books of the early 1970s, David Friedman’s The Machinery of Freedom.

I thought of it when I was lying in a bed at Sutter Health in Santa Cruz last Wednesday, waiting for my biopsy to test for prostate cancer.

Here’s what had happened. In late April, after I had had some worrying symptoms and a very high PSA score, I had an MRI at the Community Hospital of the Monterey Peninsula (CHOMP.) The test had been ordered by a doctor at Montage Medical Group, a group of doctors affiliated with CHOMP. The MRI showed a high probability of prostate cancer. The next step is to do a biopsy, and the Montage doctor scheduled it for June 11. That seemed kind of slow, but what did I know?

As we got closer to June 11, the biopsy was postponed to July 30. Again, I wasn’t really concerned. Prostate cancer tends to develop slowly, and I would have my 2.5 weeks at my cottage in Canada without fretting about the results.

But on July 16, while I was in Canada, I received a call from the scheduler at Montage. The doctor had decided to delay my procedure to September 24, a full 8 weeks later. I asked why the change. She wouldn’t, or couldn’t, tell me.

I decided to follow the Lenny Bruce strategy: find a competitor. Before I had gone to Canada, a doctor friend at pickleball said that he had heard good things about Sutter Health in Santa Cruz.

I got back home on Friday, July 26, and resolved to call Sutter Health on Monday. I pulled up the web site and found 6 urologists. The woman who took my call said that three of them had availability and I should choose one. Since I had no basis for choosing, I asked her to choose. She chose Dr. David Greenwald and I got an appointment with him on Wednesday July 31.

I liked him immediately. When he came in, he introduced himself as David Greenwald, not Dr. Greenwald. I told him that I particularly liked his first name. He smiled slightly and then got down to business.

I had had Montage fax him my records and he had obviously done due diligence. He told me that one indicator on the MRI suggested that a biopsy should be done quickly and asked me why my Montage doctor had delayed. I told him I didn’t know.

So, he lined up a biopsy for August 14, only 2 weeks later. There were 2 choices: do it through the rectum or do it under the scrotum. The latter would require more of an anesthetic but the probability of infection afterwards would be an order of magnitude lower. I liked that. Also, he gave me more information in 5 minutes than my Montage doctor had given in 10 to 15 minutes. The Montage doctor hadn’t even told me that there was more than one procedure.

Dr. Greenwald had very specific instructions for my prep: sleep on clean sheets the night before, have a shower the night before and the morning of the procedure using anti-bacterial soap, fast for 8 hours before arriving for my appointment, drink only clear liquids until 3 hours before my appointment, and then not drink at all. I followed them all.

As I was lying there waiting for my procedure, I heard the banter among the various nurses. All of them seemed as if they got along with each other. Interestingly, the 3 nurses I most interacted with—two before the procedure and one after—were men. The anesthesiologist introduced himself. He was from India and he and I compared immigration experiences. He seemed competent and had a great sense of humor.

I was wheeled into the operating room and they drugged me up. It was wonderful because I didn’t feel a thing. The next thing I knew, I was waking up in the OR and was wheeled back.

When one of the nurses did a follow-up phone call the next day, I told her that I liked every single person I had dealt with there and that the difference between Sutter Health and Montage was night and day. (I actually like the staff at Montage but I’m not a fan of the doctor.)

In this case, at least, competition in health care worked well.

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