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A half-century ago, if you or your father (and it was mostly men back then) went out to buy a car, you were immediately at a disadvantage. There was no full disclosure on prices and it was nearly impossible to compare costs at multiple dealerships. And during the actual negotiations, we were typically manipulated by classic dealer tactics, twiddling our thumbs while the salesman “checked with his manager.”

These days, the advantage has switched to the car buyer — we have reams of good data and can quickly find price info online. Here in St. Helena, I’ve bought three vehicles from Ron Clark at Zumwalt Ford and each time he’s presented me with full cost info. We also custom designed and built each car, an option not readily available way back when.

If only our medical surgery choices had progressed equally in the past 50 years. Cataract surgery, with more than 3.5 million done each year, is the most popular operation in the country. It’s become a huge industry worth tens of millions of dollars. If you polled any gathering of St. Helenans over the age of 60, I’d bet at least half have had this surgery.

For both information and pricing, all the advantages are with the sellers, the eye surgeons. It’s like buying an airline ticket: there are different prices and different levels of service. I ended up, not completely by choice, with a first-class ticket.

The common wisdom is that you’ll know when you need cataract surgery. Some folks have a hard time driving at night, blinded by oncoming headlights. Others, including me, find they can’t get an eyeglass prescription that’s clear and sharp. I was sent to Eye Specialists of Napa Valley to get a second opinion on my vision. Their very thorough optometrist, Dr. Phong Vu, confirmed that new glasses wouldn’t help me. He suggested my cataracts were “significant” and that I should think about surgery.

I was then referred to the senior member of Eye Specialists, Dr. John Bossetti, who has performed 12,000 cataract surgeries over 30 years (and taught the procedure at UCSF). I asked him if he wasn’t getting bored. He reassured me that each case is unique and therefore interesting. Doctors these days seem to be fond of metaphors and here Bossetti lost me — an avid golfer, he compared this surgery to a round of golf, each being different and challenging. Alas, I’m no golfer and couldn’t care less about his golf scores.

With millions of cataracts being operated on each year, the surgery has almost become a commodity. How does any surgeon differentiate and distinguish himself from others? And what about cost? The simplistic claim that this surgery “is covered by Medicare” and other insurance is, at best, misleading.

There are more than a half dozen replacement eye lenses that doctors can use, and some of them cost thousands extra. There are different surgical techniques available, and some of them likewise cost thousands extra. What’s the customer to do?

Bossetti’s business strategy is to charge $4,500 up front and then provide lots of customer service. He calls this a “Visual System Analysis” (VSA), but what the buyer is really paying for is his experience, judgment, and reputation. There’s nothing wrong with that. It’s like that first-class ticket where the seat is roomy and reclines, the blanket is soft, and the flight attendant laughs at your jokes.

Not only did I appreciate Bossetti’s hands-on approach, I learned to trust his judgment on what type of lens implants to use. It was an added bonus that the ones he recommended did not cost thousands extra.

Some eye surgeons use lasers to make the delicate incisions and charge lots more for that. Bossetti doesn’t and says his results are better. A local vintner pal of mine recently went to an out-of-town surgeon who did sell him on laser incisions, and said his results are better. The customer can’t seem to win.

This popular surgery is unique in that it almost always is done twice with each eye operated on a few weeks apart. I’m told Kaiser in Santa Rosa now regularly does both eyes at once, but that seems to be a distinctive rarity. Or a competitive advantage.

I had my surgery at the Queen’s outpatient surgery center, a modern building separate from the noise, confusion and crowds of the main hospital. That was added value in the competition for surgical patients.

Aside from the annoyance of many weeks of numerous prescription eyedrops, my surgeries went well. What wasn’t predicted was an immediate and dramatic improvement in my color vision. Evidently, everyone perceives colors differently, so that is why eye surgeons are cautious about forecasting this result.

Am I happy I spent $4,500 on something that’s all too frequently talked about as being cost-free? Nope. Am I glad I did? Yup. Sometimes flying first class is worth it.

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Mark G. Epstein moved to St. Helena from the East Coast early this century after a career in international business.

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