Keith Smith

As the small child continues to beg for this and that at the supermarket, the parent’s repeated “No’s” tend to bring out pouting and temper tantrums. Spankings—if you dare— don’t seem to make much difference. Eventually, the parent gets an idea. Instead of “No,” she says, “Not now.”

While this doesn’t solve the child’s disciplinary issues, introducing the variable of time (not now) softens the answer in a way that introduces hope, although probably a false hope. The time variable has muddied things for the child, buying some time for the frustrated parent.

Introducing the element of time as a variable can completely change the context of a discussion or contract. Take medical care for instance.

“Health care is a right,” many say. What the government in Canada or Great Britain really means when it says this is that health care is a right…just not now. Having waited three years for a hysterectomy or an incontinence procedure drives this home, doesn’t it? How about watching your child struggle to breathe knowing he must wait three years to have his tonsils removed? How about watching a loved one die of heart disease, waiting in line for a life-saving bypass procedure? Can the Canadian government honestly say that this now-deceased cardiac patient has a “right” to health care? It does, and with a straight face, even though the variable of time has contaminated the entire context.

At the Surgery Center of Oklahoma, we have operated on many Canadians whose government, having declared their health care to be a “right,” has failed to deliver on this promise. A Canadian can say, “I have a right to the free surgery on my brain to remove this tumor. Just not now.”

Introducing the variable of time has been useful in Canada (and in all “free” health care countries) to hide the bankruptcy of this plan, although any individual refusing to meet financial obligations—for years!— would be declared bankrupt by any definition.

Resources are limited, not infinite. Lowering the perceived price of anything to zero will empty the shelves and result in shortages. Lines will form for medical care just as they did at the gas pump during the Jimmy Carter days. Treatment may be received, but only after waiting a few years and by then, the government hopes (for the sake of its own bankrupt balance sheet) it is too late.

A cardiac bypass operation is worth more to a patient with chest pain now, than three years from now. The dilution of the value of care caused by this delay is the same deceptive technique employed by governments as they destroy a currency with inflation. This allows politicians to extract what they want now, leaving future taxpayers to pay for their current promises. This is how politicians use the element of time to buy votes. Inflation of currencies (printing money or creating credit out of thin air) results in a reduced purchasing power and a lower standard of living in the future. Delaying medical care is essentially inflation of medical care.

This is a variation on the economic concept of “marginal utility.” The first drink of water delivered to a man dying in the desert is worth more to him now than later, and worth more to him than any subsequent drink of water. A promise of a drink of water tomorrow is of no value to a man who is dying today. A dollar today is worth more than the promise of a devalued (“inflated”) dollar tomorrow.

Modifying currencies and debts with the element of time results in higher prices and different amortization schedules. Modifying medical care with the element of time results in misery or death as “not now” becomes “never,” as governments, unable to pay their bills and deliver on this “health-care-as-a-right promise,” string out their obligations further and further.


Keith Smith

Dr. G. Keith Smith is a board certified anesthesiologist in private practice since 1990. In 1997, he co-founded The Surgery Center of Oklahoma, an outpatient surgery center in Oklahoma City, Oklahoma, owned by 40 of the top physicians and surgeons in central Oklahoma. Dr. Smith serves as the medical director, CEO and managing partner while maintaining an active anesthesia practice.

In 2009, Dr. Smith launched a website displaying all-inclusive pricing for various surgical procedures, a move that has gained him and the facility, national and even international attention. Many Canadians and uninsured Americans have been treated at his facility, taking advantage of the low and transparent pricing available.

Operation of this free market medical practice, arguably the only one of its kind in the U.S., has gained the endorsement of policymakers and legislators nationally. More and more self-funded insurance plans are taking advantage of Dr. Smith’s pricing model, resulting in significant savings to their employee health plans. His hope is for as many facilities as possible to adopt a transparent pricing model, a move he believes will lower costs for all and improve quality of care.