No Free Market in Healthcare

There’s an article in CNNMoney that puts the problem we face succinctly:

I’m no fan of our existing health care system, even though it’s been working out fine for me because I’m well insured, have access to family and friends who are doctors, can afford out-of-network specialists, and have generally managed to end-run the hideous insurance company bureaucracies that drive more and more medical decisions.

With all due respect, the idea that there is a “free market” in health care for consumers is nonsense. A free market assumes that participants are knowledgeable and understand the choices they’re being asked to make. That’s not the case with health care, as anyone who has tried to analyze Medicare-supplement plans or pick among insurance options offered by his employer can tell you. Should you find yourself in a rural area far from home with a mysterious and troubling pain, you’re not exactly in a position to bargain with the local walk-in clinic or hospital emergency room.

The health care status quo isn’t going to work over the long term. For one thing, absent a huge change, the cost of Medicare threatens to financially cripple the country. Plus, we already have nonmedical forces determining how care works. Insurance companies increasingly try to tell doctors and hospitals and medical-device makers what procedures to perform, what to charge for them, and what drugs to prescribe.

That won’t be changed by putting a bureaucrat in charge of making the decisions in healthcare whether the bureaucrat works for an insurance company, a hospital, a physician, or the government.

How do you regulate things so that “nonmedical forces” aren’t in the position of determining how care works? You can’t so long as healthcare remains in the economic realm and it will remain in that realm as long as insurance companies can make money by insuring healthcare, government workers get paid for administering it, or hospitals get paid for providing it. And that will continue to be the case for the foreseeable future.

2 comments… add one
  • PD Shaw Link

    The notion of being trapped in a rural area with medical needs is interesting because English common law dating back to the Middle Ages treated physicians and surgeons as “common callings” like innkeepers and ferrymen. Travelers would do almost anything to avoid spending the night on the road and risk being victimized by highwaymen. The innkeeper had potential leverage to to pauperize the traveler, so the innkeeper was only allowed to charge a reasonable rate or what the consumer was able to pay, as well as serve all comers. Doctors were similarly operating in an area of public need in which exigencies could pauperize the patient.

    I make this point merely to suggest that medical care was historically not exemplary of free market principles.

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