Notice you never see a lot of medical practitioners or emergencies in Objectivist texts? There's a reason for that:
You can't negotiate between Most Equals, shining beings of world-spanning intellect and godlike economic prowess when your appendix ruptures.
That open market consists of "the guy with the knife, Shop-Vac, fishing line, and bread mold". Either you pay everything you have and everything you can be leveraged into promising, or you die.