Wednesday, April 16, 2008

Is it really free?

I was recently at the mall with my wife and daughter. We stopped at the food court (okay, let's be honest. We started at the food court) and ordered our meal - Torta and Burrito for those keeping score. While waiting for the food to come, I walked my daughter around in her stroller so she wouldn't get bored. As I was walking around, three different restaurants (can anything in a food-court really qualify as a "restaurant"?) enthusiastically offered me samples of their food.

I love free stuff!

But I said no, and here is why: is it really free?

Let me give you another example, this time relating to health care. Our ER would like all the nurses to know how to do splinting even though it is typically a job for the Techs. This makes sense, because sometimes you don't have a tech and even still, the tech is working under your license and so the splint is ultimately your responsibility. So in this class, there were about 16 of us nurses and the two guys from 3M giving the presentation about splinting were handing out splinting material like candy and walking around helping us practice on each other. It was educational and informative. As the teaching part wrapped up, one of the reps pointed to the huge pile of boxes in front of the room and said, "if you want to take some material home to practice, go ahead."

Did he really just say that to a room full of ER nurses?

Swarms of nurses fought their way to the front of the room and picked at the carrion as if their very lives depended on it. It was shameless. I was in front of the line. I walked away with several pre-made splints, some scissors, more rolls of coban than I know what to do with, and sundry other items, and I didn't even have the biggest pile of loot. I felt pretty good about myself.

Until the mall food court. Is it really free?

Let's think about it before jumping to any conclusions. I'll start by saying that I love capitalism. I think that the free market system works very well for the vast majority, and the principles of the free market system are sound principles; and I understand that companies have advertising budgets and figure in to those budgets that people will abuse their "free stuff" policies. Hopefully, even though my thoughts on this may not seem to be supportive of the free market, I think by the end I can show that they actually are.

In this scenario, we were all together in a class about splinting and needed to have materials to learn. We did. When he offered to have us take some material home, it was so that we could practice. This is fine. Most of the people in the class went up and got enough material to go and practice splinting at home. Then most of the people went back and got more. And more. And more. I was among them, and I don't find anything "sinful" or "evil" about it, because he did say to take whatever we want.

But I do see a problem.

The material that the company reps brought into the classroom was at least several hundred dollars worth of goods. The money to produce that material had to come from somewhere and the money that could have been made selling those goods would have gone somewhere. But, you say, 3M is a big company, and can easily eat up that cost.

That is true; however, they aren't really "eating up" that cost. What they are doing is shifting that cost onto the rest of their products. Now it might be 1/10th of a penny more per splint so that they can cover the cost of that class. This may seem insignificant to you, but to me it doesn't and that is because when the hospital pays the increased cost of splinting materials, they don't just eat up the extra cost, they pass it along to the person who got splinted, who passes it on to the insurance company, who raises premiums for employers, who decrease benefits to the employees, and on and on.

My point is, by taking everything that is offered free of charge, we may actually be punishing ourselves. In the case of the mall food court, the result of getting two samples of yum-yum chicken (yes that is what it is called, and yes, it was offered twice to me as I walked around, and yes, I refused both times because I knew I wasn't going to order it) may only be an small increase in the price of a yum-yum chicken meal. In the health care industry, however, when I take undo advantage of free samples of splinting materials, or when I abuse the kindness of drug reps, I am ultimately hurting my patients who now must pay even more for their health care, because that money for my "free" items has to come from somewhere.

So when you are considering something for free, I would encourage you to pause for just a moment and think about what you are about to get. In many cases, the free items will be helpful for you to learn and grow or determine if a product is worthy, and in those cases go for it. In many other cases just stop long enough to realize that you may be helping to inflate the cost of health care. Does that make you a good patient advocate?

Okay, for those who skip to the end of the article to just read the conclusion, here you go: Free is good. Samples and free offerings can help us determine if a product is good, and aid in getting information about a product out. I'm not trying to say that you should avoid free samples. Also, I'm not trying to make an argument about the morality of taking free items. You can go back and forth on that, and I've learned that morality is so subjective that it is a nearly impossible battle. I am talking about the financial cost of the issue. You can come to your own moral conclusions.


Addendum: My wife found a story online that I wanted to work in somewhere and couldn't find a good place. Apparently a drug rep organized a dinner at a nice restaurant and invited a number of nurses and doctors to come and enjoy the meal and her presentation. As the meal was winding down and she was putting her things away and taking questions, a doctor came in and ordered 4 racks of lamb to go and drank two glasses of wine while waiting. When the to go order came out, he took it and left. 10 minutes spent at the restaurant and $150 dollars spent for him to gain nothing from the meeting. He probably walked away thinking that he had stuck it to the man. But really, the man doesn't care, because they will just stick it to the patients by selling the drug for more money.


Nurse K said...

Now, now. What costs more? The free crap from 3M or the cost to have one of the ER staffers teach the staff how to do the splints (and prepare for the presentation, obtain the stuff, etc)? The drug rep is a free teacher. Assuming applying splints is a needed skill, the ER probably saved money overall having the rep do it.

Braden said...

I think you misunderstand me. I think it is great having the rep come and do the presentation because they know their products. The higher-ups have already decided we are going with 3M so it is not like they are going to sway us, just train us. I don't even have a problem with them offering for us to take some home to practice. I just wonder about each of us leaving with as much as we could carry.

dan said...

I think this strikes me as similar to the classic Prisoner's Dilemma game.

You are probably right that if everybody didn't take craploads of free stuff, then everyone would benefit by (slightly) lower prices.

But in practice, since everyone is going to do it anyways, your one abstention won't change anything.

And by not abstaining, you are hurting your own cause, by not getting yours, so to speak.

Then there's also the argument (It's early so I haven't thought it through to see if it makes sense) of the law of the free market.

It says (maybe? again, it's early) that 3M is going to charge the most it can get away with (to maximize total profits). So instead of lowering prices when nobody takes tons of free stuff, they just keep that as increased profits.

Anyways, interesting article.

dlh said...

Thank you Braden, I like the way you think. Been saying things of this sort for years and been laughed at. Evidently I do not have a way with words as you seem to have.