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Cost of Care

Cost of Care

Cost of Care

by Betsy Robinson

“Stella!” gasped Doctors George and Melissa Heppleberg, plastics and breast surgeons, respectively. “How can this be?”

Having witnessed this reaction before to my innovative use of free-market economics, I was well-prepared for the odd query and had taken a quick diagonal step backward after the presentation of my invoice for emergency service—so their astonished spittle landed not on my face, but on their antique mahogany vestibule mirror, where it stuck like clear pointillist detail on the reflection of their Arts and Crafts sofa and coffee table in the adjacent living room.

“I understand your confusion,” I replied, with the patience I’d learned during my life coach certification. “Allow me to explain.”

“Please do, Stella!” boomed Dr. George.

“Certainly, Dr. George. You don’t mind if I call you Dr. George and Dr. Melissa, do you?”

“Call us whatever you want,” said Dr. Melissa, pouring herself an artisanal beer. “Please enlighten us.”

“My pleasure,” I said. And I was sincere. I like my clients to understand my reasoning. I reached for my invoice, which Dr. George, holding it between thumb and forefinger as if it were a soiled diaper, dropped into my hand. “I imagined you would have learned about my billing system when you got the referral from your private wealth manager, but of course he pays through his company. Perhaps I should have explained before I accepted the booking, but it’s usually up to the client to make those inquiries. However, even if you had asked, much like free-market medical insurance companies as well as their practitioner partners, I cannot always tell a client ahead of time what I will charge because I base my hourly rates on private contracts with each client, and the full extent of the charges cannot always be calculated before the services are delivered. Allow let me to break this down.”

“Please,” said Dr. George.

“In this case, Dr. Melissa, I went to your website and determined that you charge $500 for a consultation, which usually runs 15 to 20 minutes, making your hourly fee $2,000. Dr. George, your rate was not apparent on your website, so, through a Google photo identification search, I took the liberty of tracking down several of the happy patients whose testimonials fill your beautifully designed homepage. Most of them hung up on me, however, a Mrs. Colson Pettipad, a client of our mutual colleague, the private wealth manager, was happy to tell me that a saggy eyelid consultation would cost $650, no insurance accepted. Which, rounding down as a courtesy and giving you the $50, equates to an hourly rate for you, Dr. George, of $2,400. Are you following me so far?”

“Give me a beer,” grunted Dr. George, and Dr. Melissa filled a glass.

“So averaging both of your hourly rates, we come to a mean of $2,200 per hour. Since my hourly charges are calculated according to each client’s requirements, your base charge for 5 hours of babysitting for your adorable, albeit hyperactive, preschooler came to $11,000.”

“This is absurd,” muttered Dr. Melissa, although it might have been “This is a bird.” She was two sheets to the wind when they’d returned from the emergency business dinner party with the large pharmaceutical company.

In my social work school addiction workshop I learned that these situations require patience, but never enabling. I inhaled deeply and, using my most compassionate tone, continued: “Now in addition to the standard babysitting duties of playing games, feeding, bathing, and putting your sweet but very resonant-voiced child to bed, you asked that I help him with his preschool homework. I was happy to put my first master’s degree to use correcting his composition on how vacuum cleaners—I’m pretty sure that’s what he meant—make so much noise and why people who need stuff sucked up or out—that part was a bit confusing—should just say thank you and go away. Incidentally, his penmanship is remarkable! I understand from our mutual colleague, the private wealth manager, who originally found me through the Tots to Docs Premedical Preschool, that the instruction there is visionary! But continuing—due to the cost of my two master’s degrees—English and social work—plus my many years of extended education and preparation as well as a decade as an adjunct professor of creative writing at an Ivy League school, my rate for tutoring, much like your own, is $500 per 15 minutes. We actually took 20 minutes to correct his composition—for some reason he kept calling a vacuum a ‘sucker’—but as a courtesy, I gave you the difference, bringing your balance due to $11,500.”

Dr. George went white.

“Then there is a cost of equipment.” I said affably. “Since this was an emergency, I didn’t have time for my customary individualization, but I work for a lot of doctors, so I’ve put together a generic schedule of fees based on the profit-making hospital charges of various friends and family. Would you like a copy for your records?”

As I handed it to Dr. George, Dr. Melissa dropped her now-empty glass which shattered on the honed marble vestibule floor.

“Two large paperclips—one for the itemized charges and sundry records in the packet I left for your convenience on your kitchen counter, and one for your son’s homework—approximately the length of a biopsy needle when uncurled, slightly larger in diameter, but I’m not charging you for that: $663.06. Three sterile baby wipes—your son does like to play with his food, doesn’t he?—for the dinner clean-up before we could get to the bathroom: $237.75. For a grand total of $12,400.83.”

Dr. George chugged the last of his beer as Dr. Melissa turned on her heel and staggered up the Brazilian Rosewood staircase. (Between life coaching, social work, and my masters in English with a thesis on dystopian creative writing, I briefly dabbled in interior design.)

“This is preposterous!” sputtered Dr. George.

“I can understand why you might feel that way,” I said in my most empathic babysitter voice. “I value your input and am happy to work with you. In the absence of a national, or if you’ll excuse the word, ‘socialized’ child-care program, I’ve developed a low-interest 6-month payment plan based on that of nonprofit profit-making hospitals and I just happen to have a contract with me. You can pay in full now or sign right here and mail your first month—no-interest—deposit. Just $2,066.805—which we’ll round to 80 as a courtesy. I hope you will not take this the wrong way, Dr. George, but I admire those who not only devote their lives to healing but who do so with such a healthy sense of self-worth. So I’d love to give you some business cards. Just between you, me, and that most attractive sideboard, I pay $200 cash for each referral. Now will that be check or credit card?”

And since his only reply was a death-rattle gasp—signaling his need for time to process all the information, I demurely inserted the invoice, payment plan, and a small packet of business cards into his long, delicate surgeon’s fingers. “I just love the unregulated free-market system, don’t you? You can mail me the payment of choice—within two weeks please, as my collections agency can be rather aggressive. What a lovely family you have. Toodles now. I’ll see myself out.”

Betsy Robinson’s novel The Last Will & Testament of Zelda McFigg is winner of Black Lawrence Press’s 2013 Big Moose Prize and was published in September 2014. This was followed by the February 2015 publication of her edit of The Trouble with the Truth by Edna Robinson, Betsy’s late mother, by Simon & Schuster/Infinite Words. She recently published revised Kindle and paperback editions of her Mid-List Press award-winning first novel, Plan Z by Leslie Kove. Betsy is an editor, fiction writer, journalist, and playwright. Her website is