Priceless? Really?

By: Laura Mortimer Our Thanksgiving transportation choices were clear. Option One: Drive 12 hours from Durham, North Carolina to Jackson, Mississippi, pay about $200 in gas round-trip, bring the dog (I adore the dog). Option Two: Fly 6 hours from Durham to Jackson (no direct flights), pay about $1200 for two round-trip tickets, board the dog for $300.

To recap:

Option One – $200, 12 hours, four-legged princess

Option Two – $1500, 6 hours, no princess

Economists refer to non-monetary costs (time, dog’s company, etc) as opportunity costs. Of course, other opportunity costs factored into our choice – road traffic, flight delays, gross gas station coffee, gross airplane coffee – but, as income-less graduate students with limited financial resources, we knew that money was our main constraint.

Feeling sorry for us, and generous, my mother offered to pay for one of our flights. That would have knocked our Thanksgiving bill down to $900 – a real steal for Aunt Ethlyn’s sweet potato casserole.


We thanked mom for the offer but assured her that we would much rather drive than spend an additional $1300 (of anyone’s money) to shave a few hours off our trip.

Enter that which mom considers priceless: church. If we’d flown, we could have left Sunday afternoon instead of Sunday morning. My mother was willing to pay $600 (probably more) for us to sit in the pew, and she expected us to do the same. She contends that this kind of family time – like Aunt Ethlyn’s casserole – is priceless.

I once paid $20 for a fancy bar of soap (in New Orleans, possibly after a few drinks). I am no Spock. I don’t think anyone would consider me a “heartless economist.” But I do think rationally enough to have trouble considering any thing truly priceless.

At the very least, I think about tradeoffs when resources are limited. Flying home at Thanksgiving might mean not making it back for Christmas. So it goes.

Here’s where it gets weird. When decisions are highly emotional (family holidays, wedding planning, etc), many people have an uncanny ability to ignore the limitedness of their resources. I must have felt very strongly about that lavender-scented soap in NOLA, because my graduate student budget does not allow me to buy designer soap.

I often wonder if this is a particularly American conundrum: expecting to have our cake and eat it too. American healthcare is perhaps the most striking example of this weird complex.

In 1986, Congress passed the Emergency Medical Treatment and Active Labor Act (EMTALA), which requires hospitals to provide emergency treatment to anyone who needs it, regardless of their ability to pay. Hospitals may not get reimbursed for treating these patients – hence, uncompensated care. No healthcare provider likes uncompensated care.

And yet, this same system refuses to provide insurance coverage for every American – insurance that would alleviate hospitals of the burden of uncompensated care. States that do not expand Medicaid have a gaping hole in health insurance coverage: people who earn between zero and one hundred percent of the federal poverty level in those states do not receive Medicaid or financial assistance to buy insurance on the exchange. When these people have heart attacks or car accidents, they will still receive emergency room treatment, thanks to EMTALA.

Hospitals will lose money because no one pays for these visits. Some hospitals will close their doors because these costs put them out of business. But Americans can sleep alright – for tonight, at least – knowing that we didn’t have to say no today.

We can do better than this. Look at the federal budget – or any state or hospital’s budget – and you’ll see that we have to do better. We must find ways to provide healthcare more efficiently. This means covering more people at lower costs, and finding ways to balance our emotions around healthcare and our pocketbooks. It means thinking creatively, intelligently, and objectively about how we provide care. It probably means big changes.

I am encouraging a mid-October family reunion next year, in lieu of hectic and costly Thanksgiving travel. Who says you can’t serve sweet potato casserole and pecan pie on Columbus Day? Maybe the family will go for it, maybe not. I just hope we can find ways to maintain that which really is priceless – our relationships – without placing irrational demands on one another.

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