At some point, faith in markets is like faith in unicorns. Misplaced. There is no incentive for a rational insurer to extend affordable coverage for patients with preexisting medical conditions. You can open up the state borders, and you can open up national borders, but no insurer has an incentive to do this or anything else that might jeopardize profits. Recall too that the insurance companies have a directive to increase shareholder value, not to assist in the civic goal of extending health care to American citizens. They are most assuredly not altruistic in any sense of the word that most normal people understand it. Other than this, the column has a certain fuzzy appeal that kinda seems to make some sense.

Jeff Jacoby is able to get away with this off kilter view of the Health Care Industry because he makes things up. For him to be right, you have to believe him. We all already pay for health insurance to the tune of 50% or better. Medicare, Medicaid, Veteran's Administration, Government Workers, Government Executives, and Government Representatives, and their staff. A large chunk of funds from these programs also pays for the training of medical professionals. The system has to stand ready so even though not being used at any moment by individuals, it has to be paid for. It does not spring into action at the moment someone becomes seriously ill. Doctors and nurses also benefit from treating the sick continuously so if it is your turn to use services, they have the experience to do so. Competition is also very dicey in health care since no one can predict their health needs in any given year and if they do become seriously ill it is very expensive. Moreover leaving the market to exclude or overcharge certain categories defeats the role of insurance, namely to pay providers when you are sick and not lead to financial ruin. Dividing the risk pool causes uneven and more expensive insurance premiums. This happens because to maintain such a system requires more negotiations and a more complicated bureaucracy. The real competition would come if everyone's insurance cost the same for a basic package and providers charged the same for the same services. Patients could then properly choose who they wanted to take care of them based on the quality and accessibility of needed services. The choice should not be on the insurance side but on the service provided side. That is real Freedom.

Jeff is right on target, and has articulately presented the inherent problem that standard "reform" of health care always seems to create. The most efficient way to allocate limited resources is through free market mechanisms. Regulation of markets is antithetical to this principle. The idea that government can impose regulations on an industry, to make it MORE efficient, is nonsensical. The surging prices of health care in Massachusetts proves this. The rationing of services that is being worked on now is the next inevitable step. NEW PARAGRAPH: Jeff mentions so many of the market distortions which have led to the current problem with health care-the tax deduction tied to employer sponsored insurance, the inability to cross state lines, and of course, the "fee for service" status of Medicare and Medicaid. A market based approach would have to unravel decades of government intrusion into the health care marketplace. Then, and only then, could all the providers and insurers compete for the dollars spent on health care. In this setting, prices would come down. You can bank on it.

It is simple - truly sick people are not profitable and in a "freer" health market you bankrupt them all. When you have a heart attack or you have cancer, I hope you are prepared to lose your house, Jeff Jacoby. Education is similar - if a school wants great stats the best way is to covertly or overtly exclude high need special education students. Face it, some challenges (education and health care) are not solved by the "free market". Some things we choose to do together in the interest of the society as a whole. It's humane and it creates a life worth living.

Yeah right Jeff. Yep. The free market has worked so well hasn't it? Regardless of what Romney may have implemented or the ACA is about to do it doesn't alter the fact that the only way -- the only viable way to significantly decelerate the cost of health care is via a public option. You don't have to admit it, but you know it's true. And because Obama could never get such a "socialist" idea passed, we will remain stuck in a never ending spiral of accelerating health care costs that are driving the country over the fiscal precipice -- which allegedly Republicans are so concerned about.

OMG, what? Health care reforms no PANACEA?? After explaining that the latest report is deeply flawed, Jacoby prattles about freedom, demonstrating that health policy is just one more soapbox for him to mount so he can prattle. A completely useless essay. Since when have people with less than sufficient money to afford all costs on their own been able to have predictable, competent care? For Jacoby, the market is a miracle wand. Sure, thing.

"But even if that number should be taken with a grain of salt, it is clear that universal health insurance is no panacea for health care's financial pressures — especially those that affect people with preexisting or expensive medical conditions." Wow, I actually agree with this statement. If RomneyCare has shown us anything it is that you can not provide universal healthcare through the commercial insurance market. Unfortunately you then fall into traditional conservative dogma that if only the magic elves of the free market were allowed to cast their spells everything would be wonderful. Of course you also want to continue flushing 30% of the health care dollar down the toilet to allow the insurance parasites to continue to feed. Health care is not like buying a car. If you can't afford a car you take the T. If you can't afford health care you die. You can not act as consumers do when they purchase a car. Let's say you are in a car accident and have multiple trauma. Are you planning on asking the ambulance crew what the various hospitals' charge to treat a lacerated liver? Better hurry and make your decision before you pass out. How about cancer Jeff? Will you be prepared to discuss the biology of your tumor, pharmacology of any drugs used, radiation or surgical procedures used to treat it? Once you have mastered pathophysiology, pharmacology, surgical and radiation oncology you will be ready to due a cost benefit analysis and shop for lowest price. Of course you cancer may have spread while you were doing all of this. I could go with faults of HSAs, insurance across state lines etc but it wouldn't matter. Dogma is much more important to you than reality.

The world-wide experiment in medical care (that is, all of history) proves that single payer is the only real solution. If Republicans had their way, we'd be living in the world of Charles Dickens, full of slums of poor people having children they can't feed, let alone provide health care for, working in perilous conditions and dying at age 40.

Jeff, explain to me how your unfettered free-market system will solve the problem of infant mortality (which is as high here as some third-world countries) and I'll listen. Explain how your system will ensure everyone has care and I'll listen. Explain how your system will not send so many of our citizens into bankruptcy and I'll listen. Unless you can do that, then you'll fail. But that's generally the trend with Republicans when they try to explain anything economic - they simply discount the poor, the sick, the disabled and the elderly as a write-off. Those folks have to suffer because whatever it is, it's their fault anyway. Bad decisions have consequences you'll say. It's really best when these people just die - then no one has to pay at all!!

Ending the 'state line barrier' to purchasing health insurance is certainly not a bad idea, but health care is still not a market. When you buy a car you can choose leather, cloth, or vinyl seats, depending on how much you want to pay. Not so with health. You can't control that. You don't get to decide: OK, for $50.00 a month I can have high cholesterol and a broken toe but not a heart attack. Without regulations to prevent termination or denial of coverage in the name of profit, and a requirement that everyone participate, there is no reason to have health insurance, doctors, or hospitals at all.

"The surging prices of health care in Massachusetts proves this." No. Actually it doesn't. Massachusetts has just opened the doors to health care for 439,000 newly insured(Mass Health Connector Report, Spr 2012). Immense number of deferred and ignored medical conditions to deal with among this huge group... and in a down economy. Of course it's going to be expensive at the outset. The real test will be in a few more years time when we're not just measuring the tidal wave of triage but the intended, sustainable health management of this new group as part of the whole.

In his "la-la land" musings, Jacoby basically assumes that everyone has vast amounts of disposable income to invest in this "programs" proposed as brilliant market-based ideas to save the healthcare system. Jacoby is ignoring the reality faced that most people: take care of the essential bills first, roof over head, food, transportation to get to work. The rest, for most people, remains a luxury and that means that healthcare unless it unavoidably impacts your functioning can be "left of the back burner". So, a lot of people go without insurance (well, no longer in Mass. Thank God) and forgo doctor's visits and ignore the whole thing. Also, Jacoby's musings make it sound like, oh, well, the people who have chronic and expensive-to-treat ailments, obviously have enough financial resources to cover their treatment and must be given the options to chose their provider and care... The whole argumentation is based on absolutely unreal premises... Jacoby does NOT address what happens to those who cannot afford to pay for their care. The conclusion to draw from all this is: let people who cannot afford to get care for their illnesses simply suffer and die.

So many writers here cling to the mantra that medical care is "different" since it is needed by all of us. OK, we all need food as well. I guess by this standard, the agriculture industry and the retail delivery of food should all be taken over by the government. After all, food is too important to leave to the marketplace. In truth, while there are some farm supports I object to, the low cost and ease of availability of food is because of the free market for it. Health care is not the same of course, but the immutable laws of economics still dictate that more free markets will make it easier to obtain than more regulation.

"Health Savings Accounts for the chronically ill that would allow disabled patients to manage their own budgets and choose the goods and services that best meet their needs" I've never seen such BS language before. Shame on Mr Jacobs. So what this means is, hmmm, shall i have the MRI my doctor ordered, or should i purchase the drugs the doctor says will save my life? Yes, freedom is wonderful.

Your entire argument falls apart because of the basic assumption that we operate under a free market healthcare system. We do not.

"Jeff, explain to me how your unfettered free-market system will solve the problem of infant mortality (which is as high here as some third-world countries) and I'll listen."......I will explain, I suggest in the future you do your homework............................................ "Low birth weight infants are not counted against the "live birth" statistics for many countries reporting low infant mortality rates.According to the way statistics are calculated in Canada, Germany, and Austria, a premature baby weighing <500g is not considered a living child. But in the U.S., such very low birth weight babies are considered live births. The mortality rate of such babies - considered "unsalvageable" outside of the U.S. and therefore never alive - is extraordinarily high; up to 869 per 1,000 in the first month of life alone. This skews U.S. infant mortality statistics.Some of the countries reporting infant mortality rates lower than the U.S. classify babies as "stillborn" if they survive less than 24 hours whether or not such babies breathe, move, or have a beating heart at birth.Forty percent of all infant deaths occur in the first 24 hours of life.In the United States, all infants who show signs of life at birth (take a breath, move voluntarily, have a heartbeat) are considered alive." If you want more info go to the CDC, its right on the site.

... a "free-market" system, uh? Meaning a "real," "unadulterated," free-market system... yes, real, unadulterated, just like the "white race"... it's a myth, this entirely free-market system. There can never be such a thing... there has to be regulations, however minimal, to curb human nature impulses, to address fundamental injustices... That is what world history has been about: progress. From the days when people just killed each other over nothing to a society with the rule of law... a complicated society... So-called "free-market" proponents are just wishing to live in a mythical world, not a real one.

You can grow or hunt for your own food, chief, but can you remove your own appendix if it ruptures?

What are you even talking about? He's not arguing for no regulations at all. But at this point, the government controls a large amount of health care through subsidies and entitlements. Insurance companies can't compete across state lines and there are numerous regulations already on it (including Obamacare). All these regulations have failed to solve the basic problems in health care. It makes sense to get rid of some of the most burdensome ones.

That's why we sell health insurance, which is a product. Why else would the President consider it to be a market requiring federal regulation?

Every country has a superior health care system than the U.S.A. Furthermore, Americans will not know what hit their pocket-books if Obama care becomes law. You have no idea of the massive costs that are attached to it. Don't ever forget that Corporate America developed the health care plan and they want profits.

"In short, the orthodox view is that to shield people with serious medical needs from undue financial hardship, we must suppress the normal workings of a free market — supply and demand, competition, flexible prices. There's just one problem with this approach: It doesn't work." Mr Jacoby is up to his usual tricks: Set up a false premise and then beat it to death. "The normal workings of a free market" yield not only misery in terms of health care, but also slavery, child labor, deadly workplaces, and poisoned environments. We all need to be, and thankfully are in many cases, shielded from the normal workings of the free market. Cheaper is not always better!

alby, insurance in this context, much like car insurance, only works as a product if everyone is required to purchase some basic level of coverage. Unlike car insurance, where you can opt out by not having a car, the rest of us don't get to opt out of paying for your care if you are uninsured, since the emergency room at the hospital cannot turn you away or refuse to treat you if you lack insurance. With no regulation at all, you would pay an arm and a leg for your insurance, but would be denied coverage if you actually broke and arm or a leg. As HHK2 mentioned above, France has a superior healthcare network than does the USA. Theirs is based on a requirement that everyone buy some level of coverage from national insurance run by their government. Supplemental coverage may be purchased as well.

The health care system has been essentially free market for years. It's given us the most expensive and least effective health care among developed nations. Why doesn't it work? For one example, when I'm experiencing chest pain, do you expect me to get on the phone and call around to find the cheapest emergency room? Or maybe I should call a cab instead of an ambulance? Then there's the problem that those who cannot afford the higher premiums of "cadillac" insurance policies are the same people who can't afford high co-pays and deductibles. You make plenty of money and you probably have "cadillac" insurance from the Globe. What about the rest of us? Your columns are without exception egocentric and selfish.