So Monday evening I’m playing basketball with my oldest and his buddies… My right eyelid collides with the opposing point guard’s skull – splitting it wide open… A little more than an hour later (I know, that was pretty quick) I’m on the table getting stitched up… Of course I never waste an opportunity, so I say “Doc, what are your thoughts on health care reform?” His reply was your standard right-wing “we need to do something, but we live in a country where some work hard and earn what they get, while others prefer not to work but demand all the benefits that would come from hard work”… It was the old “who’s gonna pay for it?” line…

He went on to describe how certain areas of medicine, specialists for example, still make a ton of money… He said that they’ll (he works at an urgent care unit of a local medical group) receive “a couple hundred bucks” for my visit… But if I went to a plastic surgeon, it’d probably be a couple thousand… And the hospital emergency room would cost a great deal more as well… That was interesting because on the way there Nick and I discussed the who-should-do-it question… Being that it was my face, were there such a being as an emergency plastic surgeon, it’d be a (pardon the pun) slam-dunk decision… And as a consumer with health insurance, I wasn’t thinking in the least about cost…

Now were I, to a consequential degree, on the hook financially for the decision as to how much of a scar I’ll be seeing in the mirror the remainder of my days, presuming a plastic surgeon was available, I’d have had a financial as well as a facial decision on my hands… And I suspect that in a system where it’s in the consumer’s immediate interest to, himself (as opposed to a bureaucrat), assess the cost of a given service, competition would influence its price (not to mention quality)…

Clearly the current (heavily regulated) system is fundamentally flawed… The question is are we moving any closer to a market under the Affordable Care Act?