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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

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