Friday, November 02, 2007

More Health Care Stuff From the Archives

Another post that's just been hanging around the nether regions of the lonely libertarian is this one from the Daily Kos, arguing against the concept of free market health care. I've included several comments below.

First, there's this:

Most goods and services can be priced and delivered efficiently by a (truly) free market.

Health Care is NOT one of them. You can not plan to be sick when you happend to have the money to afford treatment.

When you are sick, you do not decide which treatments are available.

when are are sick you are in no position to negociate the price of a treatment.

[T]he person(s) ultimatley responsible for the employeer based US Health insurance system is ....Adolf Hitler and PM Tojo. During WWII wages wer fixed by the US Government so employers enticed teh short supply workers by offering benefits such as paid health insurance.

Thus the US in 1946 had a comprehensive and fairly generous system of Employer Based Health Care and a Government based system seemed unnecessary to most Americans at the time.

As the rest of the world rebuilt form WWII and became serious competition for American companies those generous employer health insurance policies have been eliminated or have been severly degraded (see my post above.)

We need to shrink the power of the Health Insurance lobby until it's weak enough to drown in a bathtub.

And then this:

A truly market-based solution to health care costs would require 'perfect knowledge' by the consumer as well as true competition among providers and choice by the consumer. We don't have any of these things. The AMA and insurance companies have a monopoly (or oligopoly) on the provider market, and so there is no real competition. Along the same lines, consumers do not have choice--insurance dictates who we can see, when we can see them, and what service we can get. And, consumers do not have perfect knowledge of the product. Most consumers do not know whether, say, for a particular type of cancer, surgery, chemo, and/or radiation is the best treatment. We're at the mercy of the physician to tell us (and different specialists have different incentives to push us one way or the other) and at the mercy of the insurance companies to tell us which form they will pay for.

In general, I find these comment threads so interesting not because they represent the views of a few leftist wackos, but because I think, deep down, that these are the articulations of the feelings of a sizable number of Americans. Ultimately, I think many people come to the wrong sorts of conclusions, but at the same time there's a lot of insight to be had.

The anger and frustration toward insurance companies and HMO's is well-founded, and even among those on the left there is a recognition that our health care system is focused more on the health insurance industry as opposed to individual health care needs. There is even the recognition that our political and legal system is geared to those health related industries which are already in power. But after all that I just feel like there's a collective failure of imagination. Yes, this is the way the system works now, but it's not the only way the system could work. Far too many people act as though these failures mean national, universal coverage is the only way to go. Very few people even bother addressing the notion of actually utilizing a true free market based system to provide the greatest quality care to the greatest number of people.

The comments I've included here explicitly state that a free market for health care could never work. The first comment says this is because when you are sick, you don't decide on what treatments are available and you are in no position to negotiate costs. This is the health care at the barrel of a gun argument and it sounds appealing, but it misses a key ingredient of how markets actually work. First off, we generally do not negotiate prices on an individual level. Businesses set prices according to their supply and the demands of the market, so when you go in for treatment, the cost of that treatment has already been set. And second off, the scope and availability of treatments are just like everything else in life- there are only a certain number of options for every given situation. If your house has termites, your number of options to deal with the problem is probably not all that different than the number of options to deal with cancer.

The second commenter complains about the lack of perfect knowledge in making health care choices. After all, how can we make choices about cancer treatments when we know nothing about cancer. The same could be said about all sorts of products, and the truth is, no consumer ever has perfect knowledge. I think it is fair to say treatments on your body are a bit more costly and a lot more important than most of our other expenses, however, this is precisely what we have doctors for- to help explain these choices to us. And really, isn't this a great reason to eliminate the numerous middlemen and make health care decisions strictly decisions between patients and doctors. Or at least, that's what I'd like to see. Universal health care advocates would merely replace the insurance and HMO middlemen with government middlemen.

I spend so much of my time blogging on these issues because I feel far too many people are willing to abandon the market- some people with no reasons at all, and others with reasons that are filled with holes.


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