Wednesday, December 16, 2009

False health care system dicotomy?

Isn't there a third way beside nationalized single payer and the total financial free-for-all we have now?

Aren't the regulated utilities pretty well run and pretty cost effective at providing services or resources?

I do think Medicare for all could work well, but maybe there are other choices here.

There are anti-trust laws on the books already that should 'keep them honest' like single-payer is said to, if we better-regulated the now-free-market health care system to form a fair-market system.

Decades ago, the economist Samuel Bowles eloquently described how health care does not meet the four conditions needed for successful free markets:

1) There isn't ease of entry and exit from the market for buyers and sellers - When you need health care, you often can not wait to shop around. Similarly, becoming a doctor or other healthcare worker is not easy, and hospitals are not quickly opened or shut.

2) Perfect information is not perfectly available - As a patient with even a non-emergency illness, there is no time to learn the intricacies of health care science so as to be prepared to negotiate prices or choose products.

3) We can not assure lack of collusion between buyers and between sellers - Medical science requires extensive co-operation between healthcare providers - collusion is always possible, and organizations like the American Medical Association have seemed to most to be the best way to deal with the complexity of licencing, but necessarily range in behavior into collusion between sellers.

4) We can not practically have large numbers of buyers and sellers in each local health care market - Hospitals are big compared to patients, and necessarily so, I believe.

We will always want police in the streets, umpires on the field and someone looking over the health care system to make it work right and affordably, because this method of designated responsibility excells in large groups of busy equals with unequal power to coerce each other.

Single payer could work, but regulated utilities have also worked well in similar circumstances, and might be a workable solution that also fits the USA's character better.

Brian Cady

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