Most dismaying for me as a physician is that after all of my attempts to apply my compassion and training to save their lives, all three of these patients told me some variant of: Thanks for what youre doing, but I would rather that you hadnt. Even the man with the brain bleed, who certainly would have died without our immediate intervention, expressed dismay. In the neurology intensive care unit, with a bolt through his skull to measure the pressure around his brain, he told me that while he did not have health insurance, he did have life insurance. He said he would rather have died and his family gotten that money than have lived and burdened them with the several-hundred-thousand-dollar bill, and likely bankruptcy, he was now stuck with.

A believer in free-market medicine, Mr. Ryan has said about health care: You get it if you want it. Thats freedom. Yet being given services without your consent, and then getting saddled with the cost, is nothing like freedom.

Imagine Verizon sending you a bill for hundreds of thousands of dollars (roughly the cost of the medical care of the patient with the brain bleed who required an emergency neurosurgery and prolonged I.C.U. stay) and then telling you, We called you to offer you some extra services. You didnt answer the phone because you were in a coma, but we guessed that youd want them, so we went ahead and added them on and charged you for them. Clearly you would be outraged.

So why does this happen with health care? The answer is that we dont truly believe in free-market medicine. We know that in an empathetic and caring society, life is valued above all else, especially when the life in question is in the most helpless condition possible. Deep down inside, we all intuitively know that health care is not a free market, or else society would not allow me to routinely care for people when they are in no position to make decisions for themselves.

Republicans need to be honest with themselves and the public: If they want medicine to be truly free-market, then they have to be willing to let the next man or woman they find lying unconscious in the street remain there and die. In a truly free market, we cannot treat someone and charge someone without their consent and against their will. If we believe, however, that those lying there in their most vulnerable moments deserve a shot, then we need to push forward with the idea that health care, at its core, must be designed around a caring system that serves all people fairly.

Farzon A. Nahvi is an emergency medicine physician and an instructor of emergency medicine in New York City.

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A version of this op-ed appears in print on July 10, 2017, on Page A23 of the New York edition with the headline: Health Care Cant Be a Free Market.

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Don't Leave Health Care to a Free Market - New York Times