Free-Market Fantasies

I’m in a debate right now regarding my Free-Market Healthcare for Dummies post. Some anonymous commenter continues to insist that adopting a pure free-market healthcare system would surely drop costs, while not dropping quality of service. You can read our long debate there if you want; though you won't learn much. In my latest reply, I wrote so much that I decided to make part of it a new post. That way, at least someone will understand what I wrote.
Oh, and just so you understand, Mr. Anonymous apparently wants to get rid of all government involvement in healhcare (though he's never explained how far he'd take this) as well as ending health insurance; which includes employer-based insurance. Instead, we'd pay for all regular costs ourselves and have catastrophic insurance for the really expensive things, like heart surgery and whatnot.

I find it unimaginable how a free-market advocate can possible suggest that we forbid employers from providing health insurance as a perk; but as I said in that other post, to understand conservativism is to debunk conservatism. Anonymous has done nothing to challenge that statement. Enjoy!

Pricing Doctor A

Anonymous - You have continued to ignore my requests for an explanation of how your system is supposed to work. While you have repeatedly given the basic explanation of Supply & Demand that too many remedial students accept as reality, you haven't actually provided any actual model for how this is supposed to work in the real world. So I'll just ask a few direct questions on how you imagine this would work.

First off, the free-markets rely on informed participants. If one side has all the expertise and the other side is clueless, the market will breakdown. That's just how it works. Yet, most people have no idea how much medical care should cost. So under your system, we’re completely at the mercy of the doctors and hospitals. If they say a procedure or extra item is essential for your health and costs X amount, are you in any position to doubt them? Of course not. So how exactly is this supposed to work for setting prices, if the consumer is entirely at the mercy of the supplier?

On the other hand, insurance companies and the government DO know how much healthcare should cost, and they negotiate their rates accordingly. Yet you somehow imagine that the free-market is failing for them, making them pay much higher rates than they should. So can you explain why these experts are getting bilked by the same system that you want to force uninformed consumers to blindly trust?

Secondly, how will we decide which doctors to see? Are you really going to base your decision on price? That’s insane. Even with TV’s and cars, we take risks that we’re paying too much for a crappy product. But medical care? How do you quantify that? How can you compare a doctor that charges $85 for a physical with one that charges $135? Maybe you’re getting something good for that extra $50, or maybe you’re getting ripped off. How can you possibly know? Price is meaningless. While I find it within my ability to judge if a doctor is good or not, I have no way of quantifying that into a cost-benefit analysis; as we’d need to under your system.

And are we supposed to go to different doctors, based upon which service we need? We go to Dr. A for his cheap physicals, but Dr. B for his cheap x-rays? This is how the free-market works for consumer products, as there's no problem with switching stores to buy different products. You buy your TV from Best Buy and your stereo from Circuit City, and there's no problem at all. This obviously doesn't work so well for healthcare.

And finally, do you actually expect people to get price estimates before emergency medical care? If my daughter falls, am I supposed to go to each doctor in the area and ask them how much the tests will cost to see if she has a concussion? Should I get separate estimates based upon all possible scenarios? Will I get a free estimate, or will they charge me to look her over first? Again, this is how the free-market works, but it doesn't work so well when your daughter's brain is bleeding.

Sticking with Doctor A

And in all cases, none of this will happen. I’m not going to base my child's medical care on cost. I’m going to find a good doctor and always go to that doctor, just like I do now. And that doctor will have different rates for different services and I’ll just be at that doctor’s mercy and won’t be able to compare prices at all.

But as things are now, I don't need to. My insurance company already took care of that when they signed the agreement with the doctor. The rates are set and I don't need to worry that one of his services might be too expensive for me. I just let the experts at my insurance company worry about it; that's what they're paid for. But in your system, I'm just going to have to take my chances that I can afford whatever service I might need.

And I'm guessing that you don't have a problem with this, as you don't have kids. Hell, I rarely see the doctor too, but you just can't avoid it with kids. So far this year, all three of my kids have had mandatory vaccinations, which require well-child check-ups. My six year old had a staph infection on her finger, ringworm on her head, and a bacterial infection giving her earaches and hearing loss. My teenage daughter had two sprained ankles and a twisted knee (all on the same leg). All this got taken care of without too much hassle (though the ringworm sucked, as she had a bald spot on her head which took awhile to grow back).

I have no idea how much these things cost. I guess I paid about $160 in co-pays. None of this was unnecessary. And when my teenage daughter came in for her vaccination and well-child check-up, her doctor remembered to check her ankle and knee as a follow-up to make sure she wasn't still having problems. That's how this is supposed to work. They accept Medicaid too.

You, on the other hand, want to force me to worry about all this. You want me to call the doctor to ask about pricing before I go in. You want me to do a cost-benefit analysis on the bald spot on my daughter's head or ask my teenager to limp around school, hoping the pain goes away. Sure, maybe these treatments are cheap. But I wouldn't even know what treatment was necessary until they see the doctor. So you want me to go to the doctor, have him look at my kids, tell me what the price is, and if I can afford it, tell me what's wrong and what the cure is?

Thanks, but no thanks. I'll put up with this government "meddling" instead. I don't know what liberty they took from me, but I'll gladly allow them to if it means my daughter doesn't lose her finger or go bald.

Magic Markets

And have I ever said anything to suggest that I think we have a completely free market? Of course not. Have I ever suggested that services don’t get provided without the government or that only the government can set prices? Of course not. These are all idiotic things you ascribe to me. As with most conservatives, you can't imagine that anyone could understand this stuff without agreeing with you. So you assume we're all idiots and tell us what we believe, even when we insist that that's not what we believe. But trust me. I'm not stupid. I just disagree with you. It happens.

For your information, I am a firm believer in the free-market system. I know that it works. I’ve even explained how it works, far better than your “the markets will provide” fantasy. But it’s obvious that it doesn’t do everything and I’ve already explained this repeatedly. Is it good at getting us TV’s and cars? Sure. Is it good at providing needed services to people who can’t afford it? Of course not. It's not magic and can only work if people can sell things at a price that someone else is willing to pay. But if that doesn't happen, it doesn't work.

And yes, there are lots of countries that don’t have the regulations or government “meddling” we do. And they’re all crappy countries. But I could be wrong. Feel free to tell me about all the third-world countries with stifling environmental, zoning, and labor laws. Or third-world countries with expensive public education, healthcare, and entitlement programs. The fact is that all the good countries pay a lot for infrastructure that all the bad countries lack.

Civilization ain’t cheap. Nor is it without benefit. It's good for society to have healthy, well-educated kids. But as we see in third-world countries, there's no guarantee that these things will be provided. As they say, it takes money to make money. But if there's no direct profit in it, the markets will not provide.

Paging Dr. Walmart

As for your suggestion that quality care would be replaced with quantity care under a single-payer system, I will repeat again: IF A DOCTOR PROVIDED GOOD SERVICE, HE WOULD HAVE MORE PATIENTS. IF A DOCTOR PROVIDED BAD SERVICE, HE WOULD HAVE FEWER PATIENTS.

Because under my system, people have true free choice. They don't have to go to doctors they don't like. So a doctor with the “wham bam thank you mam” attitude will lose patients because they will choose to go to a different doctor. What is difficult to understand about that? If people can see any doctor that's in the plan, then they'll avoid doctors who give bad service. That's free choice. And believe it or not, many good doctors accept Medicare and Medicaid. Mine does. Yet somehow, you’re imagining that if we expand these programs that these doctors will drop out of the system? Huh?

In fact, you've got this entirely backwards. The real problem would occur in your system, because poor and lower-middle-class people could only afford the cheapest doctors. They would lack free choice. It is here where you'd see the “wham bam thank you mam” doctor. He can charge less because he sees more patients. Think Dr. Walmart. Under your system, Dr. Walmart would prosper and these people would get poor quality care. And no doctor who wanted to provide good service could compete with the price. And this would hurt the good doctors, as they'd lose patients. Again, my doctor is good and accepts Medicaid. Under your system, he'd surely lose patients, or he'd have to give worse service.

Having Both Ways

And what’s pathetically dishonest about you is that you’re now saying that if our healthcare gets too cheap that we’ll have waiting lines. Yet…that’s supposedly the beauty of your plan. That healthcare will get cheaper, but that we won’t lose services. Why does your system provide cheaper care that doesn’t deny people, yet you insist that cheaper care undermines my plan?

Either your plan denies service to people, or it doesn't. And if it denies service, it's Wealth-Based Rationing, just like I said it was. The less money you have, the less care you get. And if it doesn't deny service, then you have as many people seeing the doctor as I have; thus the "lines" you say I have. You can't have it both ways.

But as I said, you're just saying this because you’ll say anything you need to to make your point. And the truth is that your system would have fewer patients paying less money than my system; which would also hurt our doctors and hospitals. And our economy would suffer, as people would have more sick days and take time off from work to care for their sick kids. Freedom!

Revolutionary Changes

As for my suggestion that my system is just a slight modification to our current system, I say this because this is how we already do things. I’ve never had insurance that didn’t set prices with their doctors and most Americans have insurance. The only difference is that instead of insurance companies negotiating separate agreements with doctors, it would just be the government. And if they didn’t pay enough, the doctors wouldn’t sign the agreements; which would force the government to increase their rates. See, free-market system.

And there was a time that I didn't have employer-paid insurance, and so I didn't get insurance at all. But we were able to sign our kids up with the CHIP program, which I believe is part of Medicaid. And it worked just like our insurance does now, and was superior to some employer-paid insurance I've had. And so assuming you pay taxes, you already helped pay my kids medical care. Thanks!

And so I'm proposing just something more like that. Besides, we're already paying these amounts now, except our current system makes us pay more, as people are forced to wait until their health gets worse before seeing a doctor. Sure, we don't pay all of this as "taxes," but I've never really understood why that's such a dirty word. Paying money is paying money, no matter what you label it. But I fail to see how this is such a huge difference.

Your system, on the other hand, would be an entire revolution in healthcare. You'd force employer's to stop offering insurance. You'd deny insurance to millions and millions of people who can't afford it, including millions of children whose only mistake was being born to the wrong people. People would wait until they were very sick before they'd even find out what was wrong with them. Already struggling hospitals would go out of business, particularly those in poor neighborhoods. And even regular doctors like mine would lose business.

And again, you’ve explained nothing of how your system is supposed to work. It’s a fantasy. I don’t doubt that prices would come down, but services would go down too. We’d lose doctors. Hospitals would close. And we wouldn’t have the use of all their fancy equipment, which is where a large chunk of our spending goes. I’ve explained all this and you’ve done nothing but repeat your assertion that this wouldn’t happen. But how? Why would doctors come to our country if they could make more at home? How could hospitals remain profitable? How could our service remain the same? I can't see how this wouldn't be a disaster for us.

And for a benefit that continues to elude me. You say that you don't think doctors are the ones getting the huge profits. You clearly think insurance companies are getting overcharged. So where's the money going to come from? Who are the people sucking all the money now, which won't seriously suffer under your system? You never have explained that part. Again, I don't doubt that prices would come down under your system. I just fear that everything else would crumble down with it.

Again, I'm just asking for a slight tweaking of a system people use right now. You're taking a huge gamble that doesn't add up.

Edwards Obsession

And you really seem obsessed with Edwards plan, which supposedly forces everyone to have preventative care. I’ve barely seen anything on it, but would guess that the preventative care would only be mandatory for people who wanted to use the plan. So if you didn’t want to participate, you wouldn’t be forced to. What’s hard to understand about that?

Beyond that, I’m not really concerned with fantasy healthcare plans. Edwards isn’t even in political office and I don’t have the highest hopes that he’ll get the presidential nomination; though I wouldn’t be incredibly surprised. But I have no interest in discussing a fantasy healthcare plan that would most definitely change before it became law, even if Edwards got elected president, which is a big if. Again, I don’t see why you’re requiring me to defend a plan I’ve never even seen. This would make sense had I defended his plan. But I don't even know what it is and fail to see why you keep bringing it up.

And if we had a voluntary government-run healthcare program that you were forced to pay for, wouldn’t you prefer that the participants had preventative treatments, rather than waiting until it got expensive? Wouldn’t you rather pay for a physical and heart medicine than a triple by-pass surgery? Wouldn’t you prefer that cancer was detected in the early stages, rather than waiting until it became harder to treat? And if a bird flu outbreak occurred, wouldn’t you prefer that these people saw the doctor as soon as possible, rather than having them wait and infecting more people?

I know you’d prefer to not have such a program, but if we had one, would you prefer it to be cheaper or more expensive? Of course, these are all problems with your system too. People won't get annual physicals. They won't pay for heart medicine they need. And they'll wait until they're on their deathbed before they decide to pay for treatment. While it's cheaper to fix health problems early, the short-term financial picture will cause most of them to wait.

As I said in my last comment, I don't think you're a dumb person. But your obsession with the free-market cure-all is dumb and making you say some ridiculous things to justify your opinion. As I said, I like the free-market. I know that it works. But it doesn't always work, and in this case, it certainly doesn't. For healthcare, we obviously need something more.

I guess you disagree, but most American consider healthcare to be an essential service and it's expensive. We both have plans that would reduce costs, but only one of us guarantees service. As I've said repeatedly, there are countries where people are forced to pay for their own healthcare and education and retirement; and it usually means that they won't get any of these things. America deserves better.