Last week I took care of a middle-school teacher who was out jogging on a hot June day. Dehydrated, she lost consciousness when some tourists called an ambulance over to her. A month before that, I cared for a young man who passed out at his desk from a bleeding ulcer in his colon. His co-workers called 911 while he lay in a puddle of his own blood. And about one year ago, I cared for a 56-year-old patient who was found lying in the gutter at 3 a.m. A passer-by called 911 thinking he was drunk. It turns out he had been hit on the head with an iron rod by muggers while on his way home from work as a waiter.

All three of them had ambulances called on their behalf by bystanders. All three of them, unconscious for some or all of their care, had no say in whether they would be treated. All three of them were saddled with gigantic medical bills that they had absolutely no say in.

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 you’re doing, but I would rather that you hadn’t.” 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. That’s 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 didn’t answer the phone because you were in a coma, but we guessed that you’d want them, so we went ahead and added them on and charged you for them.” Clearly you would be outraged.