[ After having his eyes dilated, the doctor was peering into his eyes, using a bright light and a special microscope. Evan was struggling to keep his eyes open and rubbing away at them. He told the doctor to stop shining 'that light of death' into his eyes. Ya think maybe too much Starwars?]
I think he tried on every pair of boys' frames they had on display, with prices ranging from $169 to $250 (SERIOUSLY?... it's about 3 ounces of metal!) I steered him toward the lower end of the price range. We took his favorite 3 frames back to the table and tried them on one at a time, narrowing it down to his favorite which was a blue metal and highly flexible (ie Evan proof) option. The associate then went over our insurance coverage. Turns out our vision insurance (VSP, a very common plan with good coverage), pays only $139 of the cost of the frames. WHAT? I couldn't help but question the associate.
Why is the least expensive frame on the display $169 if this very common insurance plan only covers $139?
Weeellll, we do have some less expensive options in the back. Would you like me to get them?
Yes. I would definitely like for you to get them, and I don't think it's right that you don't have them on display.
She didn't respond and went to the back room, returning with about half a dozen pairs of frames ranging in price from $99 to $130. How about that? They had plenty that were within our allotted amount. They just choose to keep them hidden from their customers, and only produce them when questioned. I informed the associate that I thought that this was a dishonest practice. I could see that this conversation was making her uncomfortable, and she was beginning to get a little bit irritated. She explained that those are the 'economy frames' and they choose not to display them. Really? Don't we all want to consider the 'economy' option (no matter what the purchase) before we make up our minds?
Evan tried on each of the less expensive options, and guess what? He already had his heart set on the blue pair that he had picked out earlier. Of course he did. We had been misled, and thought we had seen all that was available to us. Normally I would have insisted that he choose one of the lower cost options (cause I'm cheap like that), but none of them were quite as flexible as the pair he had chosen. He's 6 years old, and this is his first pair of glasses. I felt like it was worth the extra 30 bucks to get something that had some hope of withstanding the human tornado that is Evan.
One might find it interesting that even after I spoke my mind on the matter, I ended up going with a higher cost item. That's not really the point, though. I should have been presented with all the available options and been permitted to choose from those. Instead I felt like they were being sneaky, and downright unscrupulous by withholding information from me. I came away feeling like their aim was to get as much money out of me (and any other unsuspecting customer) as they could.
Before I left, I shared my opinion on the matter with the Doctor (in a very calm and respectful manner... I promise!). He explained that he wanted for his clients to have a 'high quality' (read: expensive) frame. I don't think I changed anyone's mind, but at least I spoke up. And I'm STILL fuming about it.
Next time I'll be sure to ask for the 'economy options' first.
I'm with you, T, but humans are who humans are (they suck). I wish he weren't acting deceptively in trying to make a buck (and in the long run, over many repeat encounters, his behavior is counter-productive—since I would never, ever go back to him if I had an option, and neither would any friend of mine), but I do understand why he operates as he does.
ReplyDeleteYou know what makes me angrier than your doctor’s duplicity? The insurance system we live in that enables and even encourages it. Because most insurance is built along the lines you describe, health care providers are encouraged to establish “floors” for care driven by the programs of those they serve. The physician has ZERO economic incentive to provide a product or service at a rate less than that covered “free” by insurance. In the same way, consumers have no incentive to spend less than that covered by insurance. This is the ultimate (or, in a more charitable mood, I might say “one of the basic”) reasons for rising health care costs. When a system—any system—privatizes the benefits and collectivizes the cost (without proper controls), this is the result. It’s the Tragedy of the Commons at work.
Insurance is all about collectivizing the cost, though, so how do we escape the conundrum? Conceptually, it isn’t difficult. (Incidentally, the recent government attempts at health insurance reform—notice I refuse to call it health “care” reform—fail completely to understand the problem, even if it isn’t difficult to see. Too much ideology involved.) You need to tie consumer and provider choices and (economic) incentives to the problem. For example, what if insurance companies didn’t pay for the totality of the first $139, but rather paid for some percentage of the cost up to a ceiling, after which the patient (or the patient’s mom, if the patient is Evan) pays the full freight? Say the patient covers 10% of EVERY dollar spent. The insurance company could place the cap for their share in exactly the same place (never lose more than $139), so their costs show zero change. In practice, though, it would likely move—down—as systemic benefits manifested, but the important question is how the incentives have changed. Now, consumers—not just the few like you who think to ask, but ALL consumers—have a built-in and system-wide incentive to ask about cheaper frames (since EVERY purchase takes money DIRECTLY from your pocket, individualizing the costs…just a little), and that drives down prices by incentivizing providers to give quality more cheaply. The nice part about these incentives is they feed back on one another. You look for cheaper frames, and thus pay less. Doctors offer cheaper frames (to keep you from going to the LensCrafters down the street). Costs for the insurance company go down, so they can offer lower rates (or increased ceilings or other incentives to choose their plans which still allow them to make money—they’re a business, after all) and MUST do so if the environment allows for competition among insurance companies (our does not, by the way, and prices are artificially affected by the government, who can choose to neglect economic reality since ALL costs are collective in their world… Medicare is what Medicare is, broken and at the same time setting the bar for costs).
I love that an exercise in getting glasses for your whirlwind of a fourth child is a really tangible lesson in how to effect reform/change in health insurance. This system doesn’t necessarily apply to catastrophic expenses, but that’s because the economic model governing routine issues is fundamentally different, so there’s no reason to expect a “one size fits all solution. Will changes like this ever happen? Probably not…for a host of reasons with very little reference to the behavioral economic realities involved.
Of course, while I love this, you’re probably feeling annoyed at my lecture. Sorry. I couldn’t resist. I love problems like this, and I loved your story.
It makes me giggle that your comment is longer than my post! To be honest, I wasn't even thinking about the health insurance conundrum when I wrote this post (remember I'm not as smart as you:). I was really just thinking about my wallet... and doing the right thing. You do make some very compelling arguments though. When are you putting in your bid for public office?
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