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| Yes | 56% | 90 votes | Total: 160 votes | |
| No | 44% | 70 votes |
Yes
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Add to FavoritesAs (Nobel Prize-winning economist) Vernon Smith put it, the way healthcare usually works is that party B tells party A what A needs, and party C pays for it; there's no market solution to this problem. Health care consumers on comprehensive insurance plans have no financial incentive to shop around for more efficient providers and even less to choose less expensive treatment options-last year's state of the art-over new, expensive, marginally better ones. Comprehensive insurance breaks the free market and drives up costs for everyone.
Insurance is supposed to be a hedge against risk, not insulation against all costs whatsoever. The US tax code exempts compensation by provision of health insurance from income taxes, tying health insurance to employment and providing a financial incentive for employees to get as many services as possible, including routine "well-baby care", bundled with insurance coverage. Thus the tax code bears the ultimate blame for breaking the free market in health care. Amending it, and perhaps providing a shock incentive to decouple insurance from employment will reduce the prevalence of comprehensive-care plans and thus restore market pricing mechanisms to health care.
It is worth noting that parity with European or Canadian aggregate health care costs is not a worthy goal; as the low total nationwide expenditures per capita in states where health care is socialized are achieved through various, subtle forms of rationing. The object of health care reform should be to make market pricing and competition work again while preserving the freedom of choice we enjoy, even if that freedom of choice means that people with terminal illness spend until they exhaust their options. Cost of health care cannot be measured by nationwide aggregate.
Insurance- and one must be careful to not confound health insurance with health care-is more expensive than it needs to be for several reasons. Adverse selection is one; healthcare economist Arnold Kling has recommended adoption of overlapping five-year coverage periods to reduce its influence. Mandates are another: State and Federal insurance coverage mandates-requiring insurance policies to cover certain treatments, procedures, and preventative measures-make it difficult to by cheap insurance, equivalent to requiring all people who purchase cars to buy BMWs or Lexuses and banning Chevys and Fords. Deregulation, that is to say removal of these mandates, would drive down the cost of insurance, but it doesn't seem likely to reduce the cost of care.
There is, however, another form of deregulation that would reduce the overall cost of care to the healthcare consumer without necessarily driving down the cost of procedures, medications, or office visits. Total overhaul of the US prescription system could reduce the number of office visits necessary and even do away with the need to see an MD in many cases. Physicians can currently use the prescription system to maintain a racket of sorts, requiring patients to come at too-frequent intervals to get their birth control pills, insulin, or other long-term prescriptions renewed. Frequently they even lobby against reclassification of prescription medication to over-the-counter status, for no reason based on the merits or risks of the medication itself.
Ideally, no medication should require a prescription for purchase except that for which, like antibiotics, misuse causes serious externalities. Barring that, prescriptions for insulin, arthritis medication, birth control, and similar drugs should be made perpetual, by law. Additionally, the skills of nurse practitioners and pharmacists are underutilized; pharmacists should be given limited prescribing power, as they have in some parts of Europe, and the powers of nurse practitioners to diagnose, treat, and prescribe should be increased so as to be in accord with their capabilities.
Learn more about this author, Bennett Kalafut.
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No
The present situation has already proven that market forces are not at work when it comes to health care.
It has been more than 20 years since the claim was first made that market forces could drive down the cost of health care. And at first this seemed to be the case. HMO's, it was claimed, were the key to this. By making most care and medical procedures subject to review, unnecessary care would be purged from the system.
In the beginning, many of the HMO's were not-for-profits, and were committed to providing top-notch care at the best possible cost for their customers. Overtime, the number of for-profit HMO's increased. This seemed to be great for controlling costs; monthly premiums for consumers were continuously being driven down.
The result of this competition was that the not-for-profits were driven out of business, because they did not have the deep pockets of the national for-profits. The for-profits could afford to operate at a loss for a period of time, while the not-for-profits could not.
Once the not-for-profits were driven out of business, the for-profits were free to raise their rates, and decrease their quality of care. Their obligations are primarily to shareholders, not patients. And not to medical care providers.
Currently, the only form of government regulation of healthcare comes from Medicare. Medicare pays a set amount to doctors for all health care they provide. In turn, the HMO's contract with physician's to pay a certain percent of Medicare to physicians. And the amount paid by Medicare goes down each year.
Between the decreasing compensation for practicing medicine, and the increasing cost of malpractice insurance, it is increasingly financially unfeasible to practice medicine. In Tucson, Arizona, the number of physicians continues to decline, as the population increases. In some specialties, it can take months to get an appointment. There are no longer enough neurosurgeons in town to cover emergency rooms, forcing patients to be shipped off to Phoenix, El Paso, and California. For many of these patients, every minute of delay in receiving care can be the difference between life and death.
If market forces were in effect, compensation to physicians would increase, instead of continuing to go down. Because they do not, and because of the increasing difficulties in getting their patients the care they need, as well as being unable to cover their own operating expenses, many doctors are closing up shop. In spite of this, HMO premiums continue to rise, and compensation to physicians goes down. Free market forces, the law of supply and demand, do not seem to be at work in this area.
So why are costs going up? Drug companies are free to charge whatever they want for a product, and because of patent laws and the Medicare drug bill there is minimal competition.
Medical supply companies are free to charge whatever they want for products. While there is some competition in this area, it is not adequate to drive down costs.
In spite of competition, HMO premiums continue to go up every year. Their shareholders and officers seem quite happy with the financial returns.
Lawyers are free to charge whatever they want, and juries frequently give large rewards not because a physician did anything wrong, but because there was a bad outcome in spite of a doctor's best efforts.
Advanced technology comes with increased costs. An MRI may be necessary, but if it didn't exist a lot of money would be saved.
The only thing left to deregulate is Medicare reimbursement and since this is kept artificially low, this would not decrease the cost of medical care.
When market forces are working, they follow the law of supply and demand. While this means that when the supply is greater than the demand, costs go down, it also means that when the supply is insufficient, costs go up. Were market forces working with regard to the people who actually provide medical care, the cost would only go up.
As fewer of our most gifted students choose to go to medical school because of the current medical climate, the quality of medical care will eventually go down. After all, if you work in finance, you can make a lot more money without having to deal with mountains of paper work, uncooperative HMO's and decreasing compensation.
Learn more about this author, Frances Simon.
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