If the woman in “What If Quiznos Were Run Like Health Care?” [The Last Word, November/December 2009] had an insurance plan like most of my patients have, the story would have gone like this: The sandwich shop manager would have needed prior authorization to ensure payment for the customer's chips. If the customer had asked for lettuce and mustard, it would have taken extra time and materials to make a custom sandwich, but the condiments would be bundled with payment for the sandwich and not separately billable. Her co-payment would have helped to offset the difference, but the customer wouldn't be prepared to pay it. If the sandwich shop didn't provide pickles, the manager would need to refer her to the local grocery store, which requires additional paperwork and an additional co-payment. The manager would then explain to the woman that if she has questions about the ingredients in the sandwich, she can call the shop 24 hours a day, and that the store will be open late at least one day a week to provide additional sandwiches at a convenient time. The store will be liable for the sandwich and owe millions if it is unsatisfactory to the woman.

Sounds like a business that cannot succeed in a free market, yet this is what family physicians deal with daily.

Dr. Laird's Quiznos article is what we need more of! Well done!