Market-based approach misses key component: value of a human life
Jeff Jacoby prefers to replace Obamacare with “a competitive market focused on the interests of consumers,” “price transparency,” and having providers and insurers “compete in earnest” (“Kill Obamacare, and don’t stop at that,” Opinion, March 19). This is reasonable if we are talking about replacing Mom’s 2005 Camry, but it falls apart when we talk about human life.
To those in favor of market-based solutions for health care, I ask: What is a human life worth in your market? The answer is simple: All human lives are worth the same. Any other reply is repulsive.
Markets are the land of supply and demand. When there is a blight on the coffee crop, the price goes up and people buy less. Medical care does not conform to the rules of supply and demand, since much of it is governed by what is called inelastic demand, meaning that the percentage change in demand is less than a percentage change in price. My 96-year-old father-in-law had his pacemaker replaced, not because the hospital was running a special, but because not doing so meant the end of his life.
It is time to take the delivery and funding of health care out of the market.
Ever try to ask a health care provider how much a service would cost?
Jeff Jacoby complains that Obamacare is part of a “long saga of health care ‘reforms’ that have . . . banished price awareness.” Has he ever tried to find the price of a medical procedure?
I have. Basically, it can’t be done.
Once, they put a paper under my nose asking me to sign off on paying for an MRI if my insurance didn’t. I asked, “Well, how much does it cost?” After 20 minutes of serious, good-faith effort, the final word was that the billing department couldn’t give a price without knowing exactly how the procedure was coded, and the MRI department couldn’t tell me how it would be coded, because this was a kind of MRI in which they don’t decide what to do next until the radiologist has looked at exactly what they see first.
They couldn’t tell me the price of a procedure because, before the procedure, they didn’t know exactly what they would be doing.
And that doesn’t even bring in the questions of how the “consumer” can compare quality.
It is simplistic to suppose competition and comparison apply to health care the same way they apply, say, to buying a dishwasher. The economic model doesn’t fit.
We need a system that eliminates a host of wasteful practices
The Globe’s editorial on cost transparency (“Taking the surprise out of your medical bill”) and Jeff Jacoby’s op-ed on eliminating health care subsidies (“Kill Obamacare, and don’t stop at that”) share a misunderstanding of the cost structures in health care. The editorial did not recognize that insurers and health care providers carry out highly secretive and unaccountable deals that make it literally impossible to determine the costs of treating each patient in advance. Jacoby ignored that many sick people can’t earn money and therefore can’t participate in a market for health care.
The current patchwork of insurance, government programs, and employer-provided coverage actually could work if clinicians eliminated the wasteful practices that Dr. Donald Berwick and others have documented over the decades and learned to work across institutional boundaries to address chronic health conditions.
Are we going to have health care haves
Jeff Jacoby focused only on killing the Affordable Care Act and neglected the essential question: In the greatest country on earth, should health care be a right for all citizens or a privilege only for those with the means to pay?
By advocating the scrapping of subsidies, individual mandates, and coverage for preexisting conditions, he clearly seems to be in the privilege camp. It would have been so refreshing if he had admitted that these changes mean splitting America into health care haves and have-nots, and if he would reiterate how his free-market support would remain steadfast even with a family member of modest means with a disease curable only if they had money for a cure.
Our decades-long free-market approach to health care has produced the world’s highest costs and below-average outcomes. Countries such as the Republic of China and Switzerland recently abandoned free-market health care to cover all their citizens at lower costs. While every approach has its issues, advanced countries have put ideology aside to embrace government-led health care systems that produce better outcomes for all citizens at lower costs. We should do the same.
Free-market pipe dream
I wish Jeff Jacoby had pointed out just one example in the world today of a health care system that has brought down prices and increased delivery of quality medical care through the magic of competition in an unregulated free market.