letters | a free market for health care?

Complex factors make a free market for health care hard to navigate

Jeff Jacoby believes that free-market forces, as in the case of Lasik eye surgery, can effectively enable patients (i.e., consumers) to keep health care costs down (“A free market will help fix health care,” Op-ed, Nov. 28). However, two examples support Paul Krugman’s argument that health care can’t simply “be marketed like bread or TVs.”

First, Lasik surgery, a single procedure, can readily be evaluated by the consumer and immediately provides data to the free market. A bad result, and consumers will choose another seller. A diagnostic procedure, such as evaluation of nerve and muscle disorders, produces no immediate “result”; the diagnostic result leads to a series of other choices (course of treatment, facility, provider, etc.), all of which make it virtually impossible to accurately evaluate the diagnostic procedure’s marketability and thus adjust prices. The data are too complex and may take years to develop.

Here is another example. When prostate cancer was still considered life-threatening, a newly diagnosed patient was faced with at least four treatment possibilities: surgery, radiation, implantation of nuclear pellets, and watchful waiting. Choosing the “right” treatment, based on objective medical data and subjective (emotional) assessments, was already difficult. Adding the complexity of finances would have unreasonably clouded the process.


With bread and TVs, the effects of a poor purchasing decision are not nearly as powerful or long lasting as are those made in the health care arena. These differences must be respected.

Joe Megerman