The Worth of Out-of-Network Healthcare

Last week I saw a patient who was desperate for a good endocrinologist to manage her thyroid cancer and osteoporosis, so desperate, in fact, that she drove over three hours to see me. She'd been sent in by her son, who has been my patient for years, but she herself was unfamiliar with the out-of-network medical model. Unlike the rushed, twenty-minute visits so common to in-network practices, this model affords me the time to delve into a patient's full history and truly individualize care, a difference patients feel immediately.

Toward the end of the visit, she lowered her voice conspiratorially and confessed that she'd asked her husband to justify the cost of the visit by thinking of it as akin to buying her a new Chanel bag. He could wrap his head around that, she explained, something tangible, of clearly defined value, and similar in cost to our visit.

The logic, or lack of it, hit me like a punch in the chest. Her husband's mental math revealed something bigger: for a lot of people, spending real money on your own body, without an emergency forcing your hand, doesn't feel like a legitimate purchase category. It wasn't that she lacked the funds, she was just uneasy about appropriating them for her own health. Health care, it seems, feels indulgent, even though it's the most basic form of self-preservation there is. Luxury goods justify themselves. Medical care apparently needs a cover story.

I may be overreading the moment, but I think it goes deeper still. A Chanel bag has resale value and a logo that signals status to anyone even slightly fashion-conscious. Her thyroid cancer treatment and bone health have none of that: no status symbol, no dopamine hit at the register, just the invisible benefit of not dying and not fracturing a hip.

It was a small, human moment. But it says something real about how luxury goods, not health outcomes, have become the primary measure of what "worth it" means.