An important article of faith among single-payer advocates is the notion that the free market doesn’t work for health care because of a phenomenon known as information asymmetry. A typical expression of this precept can be found in Maggie Mahar’s response to a comment I recently made on her blog:
The health care market is different from other markets because the consumer doesn’t have the same power … the buyer relies on the seller’s expert opinion to a much greater degree than he would in any other market …
Mahar goes on to use a hypothetical cancer patient to show that we are all at the mercy of doctors whose word on the best course of treatment we have little choice but to accept. But this paints a very distorted picture of the health care market.
Most medical transactions don’t involve emergencies or life-and-death situations. The lion’s share of health care decisions involve such things as whether to go to the ER for a case of the sniffles or when to endure the dreaded annual phyiscial.
These days, such decisions can be made with circumspection and easily accessable information. For a case of the sniffles, a patient with an HSA might well decide to forgo an ER visit in favor of a appointment with her less-expensive PCP. And, as to the annual physcial, the internet allows the lay consumer to access all manner of useful data.
The essence of single-payer dogma on the health care market is that the patient is just too ignorant to make good health decisions without the aid of Big Brother. In the new millennium, this statist precept is both patronizing and increasingly detached from reality.
Comments 4
The bulk (roughly 3/4) of our health care dollars are spent on patients when they are suffering from a serious
chronic illness. That’s what the health care “market” is all about.
Thus, the example of a patient suffering from cancer is far more relevant to how that market actually works than the example of deciding whether to go to the ER if you have a cold.
Posted 15 Dec 2007 at 12:54 pm ¶90% of health care transactions involve the relatively minor stuff. The results of the HIE suggest that allowing the market to work for these transactions would probably ease demand enough to save stupendous amounts of money.
Moreover, “serious chronic illness” doesn’t necessarily mean medical emergencies in which there is no time to access useful data. Nor does it imply intellectually-stunted, physically helpless proles supinely waiting for the incantations of the physician-priest.
This is anecdotal, of course, but I personally know two people with chronic heart disease who have in the last six months changed doctors because they disagreed with proposed treatments or procedures.
People are smarter than you think.
Posted 15 Dec 2007 at 1:45 pm ¶‘The essence of single-payer dogma on the health care market is that the patient is just too ignorant to make good health decisions without the aid of Big Brother.’
Wrong again - it is far more difficult to make decisions faced with a myriad of competing private providers, and your present system as we well know encourages over-treatment and some bad advice - why, you posted the other day about Bexxar - but as it has to be administered in controlled settings it means oncologists who recommend it could lose their patients and their money.
As for making choice over how to treat a cold - I say get a quadruple opinion. Or concede that actually it is for serious conditions where second opinions are more important and where you are more likely to run up against medical orthodoxy and the trust factor.
Posted 15 Dec 2007 at 4:33 pm ¶“it is far more difficult to make decisions faced with a myriad of competing private providers”
I guess you are right. The government SHOULD tell us what to do.
I suppose you feel the same way about other professionals - accountants, lawyers, investment advisors - how could an average citizen EVER choose among them? There are also too many variety of automobile and toothpaste to choose from…
Posted 15 Dec 2007 at 6:48 pm ¶Post a Comment