It’s interesting how the discussion about vaccination evolved into one about health care insurance (from my May 15 posting). They are closely related, not unlike the relationship between you and the seller of your television set.

Bear with me a little here, because the analogy isn’t exact, and may be a little out of date, but in many respects the insurance provider is like WalMart or Best Buy. When you buy your television (take a job), you get a warranty with it (health insurance option), maybe even an extended warranty for some additional fee. If something goes wrong with the TV during the warranty period, you are given a list of small retailers or service centers to take it to for repair. The manufacturer pays those small retailers and service centers a fee to repair your TV, but at a much lower rate than you would pay if you went direct, without a warranty.

At one time, maybe thirty or forty years ago, those small retailers were the businesses you actually bought the television from. But they got squeezed out by the big guys. Now, the big guys sell everything, and subcontract out to the little guys to do the service.

The health insurance companies are like the big retailers. They’ve squeezed the original small medical service retailers, the doctors, out of the retailing picture, and turned them into warranty service providers.

Now, one little detail: If you do something to the TV that’s not provided in the warranty, say use a banned remote control device or remove a component, the small service provider may refuse to provide the service, claiming you violated the warranty. You can go to some out-of-network repair facility, but you’ll have to pay for the repair yourself.

That’s a little like what happened to Heidi Standish, a Ft. Lauderdale mother of two young girls, in late 2005 and early 2006, as she launched into a search for a pediatrician. The girls were then four months and two years old, respectively. She remembers calling one of the doctors in her insurance company’s network and asking an assistant if the doctor would see her older daughter, even though she wasn’t being vaccinated. The answer was no.

Then she figured she’d get smarter, and not mention vaccination to the second office. The office manager then went through a number of questions, and came to the one: “Is she all caught up on her vaccines?”

As Heidi recalls it, “I said, ‘Yes, she’s all caught up.’ So she wanted to know which ones my daughter had had.” At that point, she said her daughter hadn’t had any and wouldn’t have any, and that was the end of that conversation.

Heidi then asked an administrator at her health insurance network to check around from its list of about 15 pediatricians for one who would see Heidi’s children. The administrator “really wanted to help, and was sure she would find one.” Heidi had reason to be optimistic, since the insurance company had reversed itself four months earlier, when she wanted to deliver her second daughter via home birth. After first denying her request, it paid for the home birth.

But in this case, the answer came back a couple weeks later, in early 2006, Heidi recalls: “There are no pediatricians in our network who will take you.” In other words, Heidi had violated her warranty, which was to have her children inoculated. (I tried to contact the administrator, to determine how commonly she has encountered this kind of situation, but she didn’t return my call.)

Heidi eventually found on her own a holistic pediatrician who agrees with her refusal to vaccinate her children. The only catch: Instead of receiving the care at no charge under her insurance (warranty), she now has to pay $80 per visit per child. She is outside the network of warranty providers.

Heidi’s reluctance stems from her Christian Science upbringing, and subsequent concerns about “toxicity” of the vaccines.

As for her inability to find a pediatrician within her network, “It doesn’t feel fair,” she says. But she’s not sure in retrospect whether she would even want to see one of the pediatricians who promotes vaccination: “Why should I believe anything else they say?”

Heidi’s experience is a ringing endorsement for what Dave Milano has been arguing for—a free-market approach to health care. That would be more akin to shopping for most other personal services, like accounting or consulting, where you lay out your needs, assess the service provider, get a cost estimate, and decide whether you can work together.

It’s one thing if you have trouble getting warranty service on your television. The kind of thing Heidi encountered more resembles something our country’s antitrust laws refer to as “restraint of trade.”