(Note: I’m doing this one as a long narrative based on my recent experience with the free market side of the health care system. There are lots of links at the end of the article.)
I’m a middle aged, reasonably fit, healthy male. I stay active in skiing, soccer (against players often 10-20 years younger) and other activities, and have been very blessed in that I haven’t needed surgery to repair an injury… until recently.
I was skiing back in March with my daughter. When we were getting off a lift, the guy on my left somehow stepped on the back of my left ski with the back of his right ski, which pulled the back of my ski out to the side. I fell back on my butt with my lower left leg twisted nearly 90 degrees to the outside. Significant and immediate burning sensation on the inner side of the knee – the MCL area.
I’ve had a couple grade 2 right MCL sprains in soccer. This felt the same… but different. We were nowhere near the car, so I had to ski basically one legged the entire way back to the lift closest to the car because of the pain. I limped to the car, drove 4 hours home, and the knee was pretty swollen by then. RICE, RICE BABY. (Rest, Ice, Compression, Elevation). A couple days later, the swelling was pretty much gone.
Unfortunately, my company had dropped our medical insurance after Obamacare caused the price to more than double, and I hadn’t picked it back up, so I was cash pay. I chose to rehab at home and not go to the doctor. Within 4-6 weeks, I felt ready to play soccer, although the knee still felt a bit weak. I figured it was just the new state of things, and I played soccer for about 3 months with the knee feeling a bit weak, but otherwise fine. I ran, cut, accelerated, stopped, and scored goals pretty much like I did in 2017.
However, in August, I was playing for my team against one of our primary rivals. I played a short pass with my left foot to my team captain about 15 feet away… and felt the left knee shift/buckle inside a bit. It was disconcerting – because it had never done that before – but didn’t hurt very much. I stayed on the field and walked it off because we had no subs. The discomfort went away in about 5 minutes, so I tried sprinting again, and the knee felt ok. The next time I had to cut and twist the left knee, it shifted/buckled a bit again. I walked off the field, done. It swelled in the hours after the re-injury.
I tried rehabbing it again at home and saw some improvement, but even the slight twisting required to get in the car gave me that same shifting/buckling feeling. I went to see a local orthopedic surgeon that I’m friends with. Upon examination, my ortho friend determined that both ACLs were intact and fine (WHEW), but found that I likely had a torn meniscus. He recommended an MRI. Given that I was a cash patient, I didn’t want to do it at the local hospital, as the cost would be $2000+. I ran an internet search and found a place 1.5 hours from here that does MRIs all day for $350. Ding, ding, ding, we have a winner. I saved more than $1500 by shopping around in the free market.
I was going to have my ortho friend do the arthroscopic surgery to repair the meniscus, but he didn’t know how much it would cost (docs apparently often don’t, as prices are determined by the hospital). I contacted the hospital to inquire – and it’s the least expensive hospital in the area. The hospital quoted me a “discount” cash price of $13,400, and only about $1900 of that was going to my ortho friend. I decided to shop around and explained to my ortho friend that I had to look elsewhere. He understood.
Several years ago, I had learned about the Surgery Center of Oklahoma from a couple of libertarian/free market websites (https://mises.org/; https://www.lewrockwell.com/). The Surgery Center of Oklahoma posts all-inclusive cash prices for each surgical procedure right on their website. And by “all-inclusive cash prices”, I mean that includes the pre-op x-rays, pre-op visit with the surgeon, surgery, anesthesia, post-op visit, ice packs, crutches, etc… They’ve had a piece in Time Magazine and they have an excellent reputation. I checked their site and found that they charged $3,740.00 all inclusive for the exact same surgery that my local hospital wanted a “discount” cash price of $13,400 to perform.
That’s lower than the deductible on many insurance plans nowadays. And they partner with a loan company that offers loans for surgical procedures at rates as low as 9%.
So I contacted the founder of the Surgery Center of Oklahoma, Dr. Keith Smith, by email. Within an hour or so, Dr. Smith responded and offered to refer me to one of the 40 or so surgeons who use the facility. I wanted to make sure the surgeon I was referred to was experienced and good at his job, so I looked him up. The surgeon referred to me was Dr. Kevin Hargrove. I found that “Dr. Hargrove has served as the team physician for the United States National Softball Team since 2004 and was a United States Olympic physician for the 2008 Summer Olympics in Beijing. Dr. Hargrove was a United States team physician for the 2007 Pan Am Games and has traveled to several international events for a variety of Olympic trial events.”
I felt pretty good about Dr. Hargrove’s experience.
I bought plane tickets for my wife and I, reserved an AirBnB for three nights at $65 per night (for a three bedroom duplex with full kitchen), and a car through Turo (the AirBnB of car rentals – it’s great, try it. I’ve used it 5 times so far. This time it was a 2012 Mercedes C Class at $40 per day). It appeared I was going to save about $8500 by traveling to Oklahoma City for the surgery.
We traveled to OKC. The lady renting us the Turo car met us right outside baggage claim immediately after we got our bags, showed us the car, handed me the keys, and my wife and got in. I drove us to the surgeon’s office, which was REALLY nice. I filled out the paperwork; they called me back about 10 minutes later, took 4 x-rays of my knee, and I met with Dr. Hargrove for about 25 minutes. He seems to be a great guy with a dry sense of humor that I appreciated. Dr. Hargrove and his office were very efficient and everyone was very friendly. Not your “average” hospital/doctor visit.
We left to go to our AirBnB 10 minutes away, and unloaded. We followed that up with a GREAT dinner with a friend in the area, then went to bed and got up to be at the Surgery Center at 8:30 (the very nice waiting area was probably 2500 square feet with lots of chairs and a play room for kids). I filled out their forms, they called me back about 5 minutes later, took me to pre-op, had me change into a gown and sat me on a gurney. Nice facilities back there, as well. One nurse shaved the area around my knee with an electric trimmer, and another nurse took my blood pressure (150/90! – apparently having your first surgery is a bit stressful) and put in the IV with saline. The anesthesiologist came into pre-op and introduced himself. Everyone was very friendly. They had my wife come back for about 5 minutes to check in and take my wedding ring and clothes.
The nurse had me lay back on the gurney, allowed me to get comfortable, and brought me a blanket that had been warmed – it’s chilly in pre-op and they’re kind enough to realize that and do something about it. The nurse wheeled me into the operating room and had me scoot from the gurney to the operating table. I was resting there, while 3 or 4 other medical personnel in the room went about their jobs. Each of them introduced themselves and explained what they were doing during the procedure. I was having a conversation with one of them… and then I wasn’t…
I woke up about 40 minutes later in a nice recliner covered in another warm blanket. I was pretty groggy, but had no noticeable pain. The nurse brought me some club crackers and water and encouraged me to eat and drink, which I did. In about 5 minutes, I was feeling a bit more clear headed and they brought my wife back. A few minutes later, I felt well enough to leave, so they sent my wife to pull the car around. When she came back in, they handed me the crutches, helped me out of the recliner, and I got up. I started walking with the crutches, but I had my balance and my knee felt pretty good. After about 5 steps, the crutches seemed pointless and I started walking with both legs to the car. I carefully got in the car and my wife drove us back to our AirBnB.
They prescribed me Oxycodone at 1-2 pills per 4-6 hours. To be honest, I never had any significant pain – in fact, the only pain I really had was a slight to moderate burning sensation around one of the incisions. But nothing that really called for Oxycodone. I took some anyway in hopes of heading off future pain, but by days 3 and 4 post-op, it was entirely pointless and I tapered it off to nothing by day 4.
I was supposed to ice the knee for 48 hours to keep swelling down. I tried, but the ACE bandages were so thick (and I wasn’t supposed to remove them) that I couldn’t really feel the ice. Hmm… But I never had any substantial swelling and was walking (carefully) without crutches all over the AirBnB duplex as soon as I got up from a post-op nap. My wife took good care of me (while trying to keep me from moving around too much… LOL).
The day after surgery, we went back for the post-op visit. I walked in carrying the crutches and the nurse was surprised and slightly amused. The surgeon thought I was doing fine and said I didn’t really need the crutches. He gave me the photos of the inside of my knee, explained what he had done in there, told me I’d probably be good for normal activities in a couple weeks, and sent us on our way. We went to the 5.11 Tactical store for an hour or so and I walked around the store quite a bit. It turned out that one of the employees there had Dr. Hargrove do meniscus surgery on both his knees at the same time last year – and he was up and walking without crutches in two days. My knee started to feel tight after half an hour of walking around and I sat down while my wife finished shopping. We then stopped at Red Robin for dinner and went back to the AirBnB. No pain to speak of.
We got up the next morning and I was able to take off the bandages and shower with a plastic bag around the incisions – they were three small incisions that had one stitch each in them. We got dressed, drove to the airport, met the owner of the Turo car, handed her the keys, checked in, and got on the plane home. I was a little uncomfortable for some of the flight (who isn’t…), but was never really in any pain.
As I write this, I am 9 days post-op. I started light rehab two days ago and had my GP remove the stitches yesterday. I’ve been icing, using a TENS unit and stretchy bands, doing spin bike and chair squats. The knee already feels better and more stable than it did before the surgery. My goal is to be ready to ski three weeks from now… but frankly, I feel like I could ski tomorrow if there was any snow at the resort. That’s amazing to me given it’s only been 9 days since the surgery.
All in all, it was a very good experience and I would certainly do it again – especially since it was $8500 cheaper than staying home. Unlike most of my prior visits to medical facilities, the entire experience was better than expected. I highly recommend Dr. Kevin Hargrove, the Surgery Center of Oklahoma, and free market health care. I also recommend getting away from the “normal” government/insurance dominated medical industry. Give your business to free-market facilities and physicians if you can.
Interestingly, there are a number of similar free-market medical facilities popping up all over the country. Medical care can and would be a lot cheaper in this country if we’d figure out a way to get insurance and government out of setting the prices. The Surgery Center of Oklahoma and Dr. Kevin Hargrove have figured out one way to do that. Note that if you have health insurance, you can try to negotiate with them in advance of your surgery and see if they’ll pay the lower cash prices at facilities like the Surgery Center of Oklahoma. Now for the links:
Dr. Kevin Hargrove’s website:
The Surgery Center of Oklahoma’s website and pricing:
The Blog of Dr. Keith Smith, Founder of Surgery Center of Oklahoma:
Podcast with Dr. Keith Smith:
Time Magazine article on the Surgery Center of Oklahoma:
Article on the excellent customer service at the Surgery Center of Oklahoma:
Ways to find other cash pay/self pay medical facilities across the country:
Other articles on cash pay/self pay issues:
Discussion of problems with medical care and medical insurance in this country:
AirBnB and VRBO house/apartment/room rentals:
Turo Car Rentals: