The concept of “having skin in the game” is popular among those who still believe we can utilize the free market to rein in the cost of health care in the United States. The idea is that if people have to pay a decent percentage of the cost of medical care, they will turn into savvy medical shoppers when they need to see a doctor. This, in turn, will bring the costs down, ultimately resulting in a more affordable health-care system.

That’s the theory. The reality is different. Last week in Boston, Maria Cramer, a reporter for the Boston Globe, witnessed a horrifying accident on the city’s mass transit system:

Awful scene on the orange line. A woman’s leg got stuck in the gap between the train and the platform. It was twisted and bloody. Skin came off. She’s in agony and weeping. Just as upsetting she begged no one call an ambulance. “It’s $3000,” she wailed. “I can’t afford that.”

— Maria Cramer (@GlobeMCramer) June 29, 2018

A nurse who witnessed the aftermath of the accident said the victim most certainly needed an ambulance.

It seems almost beyond obvious to say that there is something cruel and out-and-out immoral about making people think about their financial skin in the game when their personal dermis is literally hanging off them. Other developed countries do not do this, and somehow they manage to spend less money overall on health care and often get better outcomes, too.