Not every problem has a "free market solution." In the case of health care, promoting the market society and promoting well-being are fundamentally contradictory ends.
"Now you sound like a lefty," host Chris Hayes told Elise Jordan, the lone conservative panelist on Sunday's Up with Chris Hayes. Jordan, a former communications director for the Bush-era National Security Council, had just taken a stab substantively critiquing the Affordable Care Act from the right. The problem, she said, was that the bill had not addressed some of the deeper flaws in the health care system.
The architects of the bill, she said, "tried to satisfy too many parties. And so they made insurers happy, they made pharmaceutical companies happy, and they didn't achieve real reform." She went on: "Why do Americans not know what a service is going to cost when they go to the hospital or the doctor's office?"
A bleeding heart, pro-single-payer progressive couldn't fault that argument. But Jordan parted ways with the left when she stated her preferred remedy: "I want a free market solution."
Tellingly, that's where she stopped. It was an odd way to close, for reasons that co-panelist and radio host Sam Seder abruptly seized on. "There is no free market solution to the problem that you're talking about," he said. "That is a function of the free market."
Whether or not there is, in fact, a free market solution to fixing American health care probably depends on what constitutes a "solution." Is creating and sustaining markets in all sectors of society an end in of itself? Or is universal health care coverage the goal? Seder touched on an important point, which is that these objectives are in tension with one another.
Later in the show, Chris Hayes illustrated one reason why. "The key market mechanism is that I walk into Bed Bath & Beyond, and I decide, I want those shower curtains or those shower curtains, and then I price it out and I can decide my preference," he said. "I don't have a shower curtain doctor who comes in and says, 'Based on my expertise in shower curtains, you have to get this shower curtain.'"
Additionally, no one sees universal shower curtain ownership as a valuable policy goal. The consequences of not being able to afford a shower curtain are that you don't buy a shower curtain. The cost to society is that Bed Bath & Beyond doesn't make the $20 they would have otherwise made off of your purchase.
The calculus for health care is considerably different. If you can't afford that, then the consequence isn't just a wet bathroom floor; you might actually die, which carries its own considerable societal costs. You can conceive conceive of those costs in economic terms (a potential producer and consumer of value going to waste), but we don't need to think about dollar value in order to see why people dying is a bad thing. All but the most hardcore, Ayn Rand-worshipping market fundamentalists tend to see preventing needless death as a worthwhile policy goal in and of itself.
But you can't orient a functioning free market around that policy. Let's go back to the shower curtain example. Say that we lived in a society where it was considered morally unacceptable to let anyone, even the most unfortunate members of our society, live life without a shower curtain. So if you go to Bed Bath & Beyond and tell them that you don't own a shower curtain and can't afford one, they have to give you their cheapest model for free. You can pay more for a nicer curtain if you'd like, but there's no chance of you walking out of the store without any curtain. There's still a market for curtains, since people still have variable curtain preferences, but the market is much more limited.
A truly free market alternative is simple: if you don't have the money for a shower curtain, you don't get a shower curtain. If you don't have the money for medical treatment, you don't get any of that, either. Depending on your priorities, you might be fine with that. But if you consider fostering markets everywhere a lower priority than keeping people alive, then the distribution of medical care is probably something you want to insulate—at least in part—from the vicissitudes of a market economy.
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I never have understood why this aspect of the conversation has never been in the serious national debate. We have kown that this was going to evolve into an affordability crisis for, now, over fifty years. I read and hear certain portions of society, mostly in one of the healthcare industry groups, having conversation, but, not seemingly in the public sphere (possible exceptions being Kaisar and Health Affaires).
Now, we seem to be at such a severe level of discourse, that everything is political and very few will even listen to other viewpoints. Guess, when we see millions suffering from a lack of care, something may happen. However, MSM would have to push harder to get, what is going on, out to the public. At some point, someone will yell the obvious, "system is broke, and, needs fixing". Maybe Chris is the first scream.
Nobody knew there would be a health care crisis 50 years ago.
Please, please, please stop guests from declaring that patients who go to a hospital ER for health care "don't get a bill". They DO GET BILLED. I know this because I've paid several of those bills for my retarded adult niece before she was covered by Medicaid. Just because poor people are poor does not stop the system from charging fees. And forwarding the unpaid bills to collection agencies.
Ditto.
After ruining the victims credit, the ER submits a bill to county, state, or federal.
The affordable care act stops them from ruining peoples' credit and forcing disabled relatives into bankruptcy.
The only solution to the health care crisis is a Medicare for all public option period. How do we pay for this? We can start by raising the $106,800 cap for Social Security and Medicare up to $250,000 as Senator Bernie Sanders has suggested. We also would lift the burden of private health insurance from employers. Making those employers pay a known consistent Medicare tax would be less than what they have to pay for private health insurance. So I don't see paying for a Medicare for all public option nearly as awful as many critics think. We will have a Medicare for all public option, or some version there of, much sooner than anyone thinks. Here is why:
Let's look at the cost of health care in relationship to median income. The median income of Americans was about $54,000 in 2007. Median income actually went down after this last recession to around $48,000. The lower median group are made up of Americans who work for small businesses or small corporations. The cost of a family health insurance policy was about $6,000 in 1999. By 2010 that same family policy increased to over $13,000 annually. By 2020 this same family policy will cost over $26,000 annually. Also not included are all the co-pays, deductibles, and fees that will add many thousands of dollars to a family policy.
Here is the bottom line that few people ever talk about: the lower median group of Americans work for small businesses and companies that will no longer be able to afford health insurance for their employees. This will leave over 150 million Americans in serious danger of being uninsured or under-insured. Imagine a world where up to 100 million Americans are uninsured or under insured? If you are in the upper median group and earn $50K to $100K annually you will be faced with cost shifts that hurt your dramatically. The bottom median group not having health insurance or being under-insured will make health insurance so expensive that increasing numbers of people in the upper median group will also become uninsured or under-insured. So no one will be happy with this system once the costs start shifting to an even greater degree than they already are.
I never hear anyone on the right talk about what $26,000 insurance costs in 2020 really mean for our employer based health care system. The reality is that our fee for service system health care system is a dead man walking. Our employer based health care system will implode like the Soviet Union imploded at the end of the Cold War. Our health care system is pricing itself into extinction. We currently have 50 million uninsured in America. We have at least 20 million under-insured. Now imagine in 2020 having 70 or 80 million uninsured and 40 or 50 million under-insured with everybody else getting ever increasing costs for premiums, deductibles and co-pays. So everyone will either be angry or more desperate to pay for their health insurance by 2020.
We should look at why the British enacted the National Health Service in 1948. The British NHS was enacted for national security reasons. The British military services complained bitterly to Parliament about the number of recruits that were rejected for military service on medical reasons. As a 20 year Army Sergeant who trained troops, I can tell you that many recruits put out of the service for medical reasons came from families without adequate health insurance coverage. So what you say? When we spend $500,000 training an average soldier to one million dollars training many job skills and the soldier does not complete their first year it is a real costly deal for the taxpayer. If the Joint Chiefs of Staff made the argument that we needed a Medicare for all public option for our national security needs because we are not getting healthy enough recruits into the services you would see 90 votes in the U.S. Senate for a Medicare public option. Having observed this troop training problem caused by troops who received inadequate health care in their homes, in the U.S. Army for 20 years, I can tell you the British made a wise decision in 1948 that we must make now. Healthy recruits also make healthy productive workers for civilian employers as well.
The British NHS emphasizes preventive family care medicine and well baby programs, pediatric care, and vaccinations for children and has reaped huge cost savings for it. Not only are British recruits healthier today when entering service, British companies have more productive work forces and predictable costs for their businesses. The British provide excellent health care for 9% GDP while America we pay 17% GDP and have 50 million uninsured. Australia, New Zealand, and Canada all have universal system slightly different than the NHS but they too provide excellent universal coverage for about 9% to 10% GDP.
If the U.S. is ever going to compete in the 21st century global economy we must adopt a Medicare for all public option. Our industrialized competitors all have single payer systems of varying types. GM pays $1500 in health care costs to make a vehicle in the U.S. than the same model in Canada. So the idea that we can some how just keep our current employer based system any longer is total hogwash. The status quo in this country is totally broken and has to be fixed. We will have a Medicare for all public option period. Its just a matter of how many more years of vastly increasing numbers of more people dying and going bankrupt in America do we wish to tolerate before we decide enough is enough? I will let you in on a secret, it will be before 2020. Our health care system is a dead man walking waiting to collapse into the ash heap of history. A Medicare public option is the only reality facing America.
You left out something.
The solution is to create more physicians.
The problem is market scarcity. Physicians unemployment rate is about 0.1%.
Annual income is $150,000 for GP and $300,000 for specialists.
We need something similar to a domestic peace corps that can satisfy basic needs for less.
The reason for the problem is that physicians income has been increasing at double the rate of inflation because medical schools graduate too few physicians, and that has been creating market scarcity for physicians since 1980.
Market scarcity drives up demand, and that drives up cost.
Very simple situation.
Left out something.
The problem is education scarcity.
No medical schools opened since 1970 as the population doubled.
Same number of physicians graduating but double the number of customers.
A lack of family care physicians is a legitimate issue. But the reason so many physicians choose to become specialists over family medicine is that specialists get paid more money. The public needs to help young doctors pay back medical school debts by having them go into shortage areas like OB-GYN and family medicine including pediatrics. I don't have a problem with more medical schools but the real issue is 50 million uninsured turning into 70 or 80 million uninsured along with 20 million under-insured turning into 50 million under-insured. The bottom 150 million people in the lower median income group will face a bleak future without a Medicare for all public option.
The concept of insurance itself goes against the pure idea of free market. Insurance mandate provide an essential role in any insurance enterprise. There's a mandate for car insurance, public buildings have to have fire/liability insurance, homes in certain regions have to have types of disaster insurance.
Yes there is voluntary forms of insurance, but people need to remember that they are provided by the same companies that also make money from mandated insurance. Without that revenue stream, no company could feasibly be able to sustain itself solely from a model of providing voluntary-only insurance.