No choice

Why choice is the last thing people need with their healthcare

March 16, 2017
Jonathan Libov

This content of this post does not necessarily represent the views of my employer, Figure 1

Figure 1 is an app where doctors and other healthcare professionals share patient cases and talk about them. I work as a product manager at Figure 1 and look at medical cases all day everyday. Here is an example of a case on Figure 1: A bone broken clean through from a gunshot. It’s amazing that doctors can fix this.

broken bone

“23yo male, clean through-and-through GSW to R thigh. No major neurovascular compromise, otherwise stable. Admitted to ortho. X-ray is about as good as it gets! Entrance and exit wounds also very distinct in the image.” Case by ekimffils

One recurring theme on Figure 1 is, “How in the world did it take so long for the patient to visit the hospital for something that severe?”. These aren’t cases about people who hurt themselves and stopped at Dunkin’ Donuts on the way to the hospital, but rather cases like: A man with a three-year-old tumor in his chest that had grown to the size of a basketball who only came into the hospital because he slipped and fell on the tumor. That’s right, he only came into the hospital because he had injured his tumor.


“70 yrs old/ gentleman / brought in by family members for swelling on the chest wall for the past 3 yrs. Patient was seen by both surgical and onco 3 yrs ago. Refuse chemo/ radio / surgery. Came in because slipped and fell on the tumor the day before.BP :70/45 PR: 120. Hb:4. What would be your management for this patient? (health care is free in the country I practice)”. Case by prasannah.

If you’re thinking, “It’s sad that he was not able to afford the care he needed”, you didn’t read the caption. This patient was in a country where healthcare is free.

Another case, far too graphic to include in this blog post, depicts a patient who came into the ER with left foot pain. The foot was so damaged from infection and neglect that the skin had been sheathed off below the ankle, and the color and integrity of what remained left many wondering how the person was even alive, let alone coming in for “left foot pain”.

Indeed, many commenters on Figure 1 asked why it took the person so long to get treatment. One responded:

Can people please stop asking why it took pts so long to get [treatment]? Not just this case, but these comments appear on so many cases. There are many many reasons, ranging from finances, fear, lack of understanding, lack of access to being concerned about how they/their loved ones will cope (especially if pt is carer for a family member).

Healthcare is an emotionally fraught ordeal and no less than an intellectual maze even before you account for insurance and finances. So when the GOP touts “choice” as the American Healthcare Act’s solution to healthcare problems, the only rational answer is “Choice is the last thing we need to introduce into the equation”.

And no, ACA (aka Obamacare) was not and is not the long-term answer either. Speaking both as a product manager and a one-time user of ACA, it is a shitty, confusing product. It wraps all the emotional and intellectual complexity of healthcare in a complex financial marketplace that is beyond the ken of almost every consumer.

Good, simple products look like this, from an early advertisement for the UK’s National Health Service (via Democracy Journal’s Keep It Simple and Take Credit):

national health service

The answer isn’t necessarily single payer (however, having lived for five years in Israel, which is single payer, I can say that it’s a hell of a lot better than what we have here in the US). In fact the problem isn’t even really insurance. It’s healthcare costs, which continue to increase unabated in spite of efficiencies brought about by technological advances.

Why was the healthcare product better in Israel? Primarily because it eliminates choice. You don’t need to check whether a doctor is on your plan, nor remain on alert that the doctor is going to offer you something that your insurance doesn’t cover. Understanding what your insurance covers is really hard when you’re at home with your partner, turning the pages of your healthcare plan; it is impossible while sitting in the doctor’s office or hospital, possibly alone, half-clothed, divorced from your phone, suffering from some ailment. Or while enduring the pain of ejecting a human from your womb, in need of an epidural that has been marked up hundreds of times the wholesale cost.

It’s at moments like these that the only comforting thing may be that you’ve never been asked to make a choice.