Saturday, July 01, 2017

Modern medical care precludes a “free market”

One of the latest to call for a free market in health care is Bert Stephens, one of the New York Times “conservative” columnists.  His latest column, “A Price for the G.O.P.’s Health Care Insanity”.  He takes on Obama for creating the mess and the Republicans for making matters worse with their “fixes”.

He blames it as the “third party problem”; the consumer of health care does not shop around for the best deal but depends on an insurance company to pay the bills.

There may still be a free market in dentistry, but there cannot be a free market in health care.  Why?  What is one of the criteria for a “free market”: many sellers.  We have long ago lost many of our independent doctors: they are mostly in large clinic/hospital complexes.

In Duluth, Minnesota, we have two choices: Essentia Health or St. Luke’s.  It may still be that if you have company-provided health insurance, then your only choice may be a given clinic.  I know that we have switched clinics when we switched jobs.

Oh, sure, if we can’t get into one of these clinics or decide an out-of-town clinic is a better choice, we can drive a few hours or stay overnight to visit other clinics.  My wife couldn’t get into a dermatologist in Duluth and so drove to the Twin Cities.  We have had several friends who have stayed in Rochester to use the services of the Mayo Clinic.

There are certain specialties that are available outside the clinics, such as eye care.

A clinic may give you a choice of doctors, but you are often limited to those who have current openings in their schedule.  If your doctor leaves the clinic, the clinic may assign you to the next available doctor  I don’t remember if I chose my first cardiologist, but I know I was assigned to another when my then current cardiologist went elsewhere.  When my cardiologist decided that I needed heart surgery, I was assigned all the subsequent surgeons.

Another consideration is our knowledge of the available doctors.  Do we know who is available?  Do we know their credentials and reputations?  A free market includes having all the information to make a decision.  Very few of us will take the time to get the information, or, if we get it, have enough knowledge to make a decision.