Anything Different About Medical Care?

by Don Boudreaux on May 3, 2006

in Health

A reader writes to ask me

to explain in more detail why [I] think free market
ideas apply as well to healthcare as to  other things, given two factors:
that life and health are of overwhelming importance to everyone; and that
most people don’t know much about medicine or good healthcare.

I’m never quite sure how to answer such a question because I
always am unsure just what the question really is.

On its face, you see, the question is easy to answer.  Health care is an input into extending life
and making it more enjoyable.  But so,
too, are food, water, clothing, and shelter. (Indeed, save for health-care in the most extreme circumstances, a
person can live much longer without medical treatment than he can live without
food or water.) The very same
public-choice and knowledge-deficiency problems that prevent government from
effectively supplying food and housing prevent government from effectively
supplying health care.

There’s simply nothing about the importance of health care
that distinguishes it from many other goods and services routinely supplied by
markets.  Or, put differently, nothing in
the theory of markets is built upon the supposition that goods and services
aren’t “of overwhelming importance to everyone.”

As for most people not knowing much about medicine or good
healthcare – the same is true of internal-combustion engines, computer software
and hardware, pencils, and almost everything else produced and sold in a modern
market economy.  Of course, the qualities
of some goods (such as pencils) are easier than the qualities of others (such
as open-heart surgery) for non-experts to evaluate.  But our world is chock-full of institutions
that address such problems: department stores evaluate the quality of clothing
and draperies so that non-expert consumers don’t have to learn about stitching
and textile properties in order to make secure purchases of clothing and
draperies.

In the U.S., government – in league with the American Medical Association – certifies that
physicians are of at least minimal quality.  (Without such government licensing, I’ve no
doubt that private means of certifying the quality of physicians would arise.) Physicians themselves are agents for their
patients in choosing medications and medical procedures.

I simply don’t see anything about health care that makes it
naturally immune to market pressures.

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{ 42 comments }

Don May 3, 2006 at 5:37 pm

The reader might be driving at price sensitivity. I have had people argue to me that consumers of healthcare are relatively insenstive to price because, well, it's their health. Thus, providers and the agents within the healthcare system can unfairly (whatever that means) raise prices becuase people will pay. This is a highly complex question. People are insenstive to certain prices, but this is more a function of the fact that prices are distorted through the third party payer system. If we had prices that were more free to reflect value, I think there would be more evidence that people do weigh costs and benefits against their alternatives. It does happen. Rather than go on statins or expose myself to expensive heart surgery, I have chosen to modify my diet, exercise more and (best of all) drink more red wine. These choices would be more abundant for us if prices weren't distorted.

And as to the fact that most people don't know much about medicine, this argues for more market-based pricing. We need to ensure that caregivers get the proper value for their services so that 1) they are fully incented to invest in the intellectual property of medical knowledge, and 2) we allocate medical expertise properly to where it is needed most (i.e. we have too many sports medicine experts and cosmetic surgeons and not enough OB/GYNS and cardio-thoracic surgeons).

save_the_rustbelt May 3, 2006 at 5:44 pm

Let me suggest "decision complexity" as one possible glitch here (I'm not arguing this, just suggesting it as a possible problem).

For example, go to your family practice physician and complain of low back pain. The decision tree is quite complex, the physician will make recommendations using his/her best judgment.

Many of the decisions are non-decisions, do diagnostics and then consider the additional data, then try to make a decision.

quadrupole May 3, 2006 at 5:54 pm

Let me suggest that there is just as much 'decision complexity' involved in deciding what to eat or drink, and we seem to do just fine.

For example, go to your local grocery store to buy food for dinner. You have an incredible array of choices, all of them having quite differing effects on your health and wellbeing. You can get a recommendation from a nutritionist, but even when they do, most folks don't use that as their only input. And one can make a very good case that the quality of what one eats day to day has a very significant effect on your health.

Steve Plunk May 3, 2006 at 6:35 pm

I'll throw in that government regulation is a bigger force in the breakdown of the market than acknowledged.

The government not only certifies the competence of physicians it also helps determine the number of physicians. Working with medical schools the government can control how many doctors are trained, supply, and therefore have an effect on price, high.

Drug regulation can also have an effect. It will be interesting what happens now that a court has ruled patients have a right to experimental drugs to save their lives.

I have said for years the problem with health care is not getting more money into it through health insurance but how do we control costs through free market initiatives.

donny May 3, 2006 at 7:10 pm

Here in Canada, medical services are "free", and we have a chronic shortage of nurses, doctors and equipment.
Dentistry is paid for by the patient, and readily available, and I can't remember a shortage ever.
When someone suggests that doctors should be free to offer their services on an open market, everyone goes crazy here about "two-tiered" medicine, one for the rich and one for the poor; but we don't have two-tiered food, and we don't have two-tiered cars, and we don't have two-tiered houses; the market provides a wide range of goods at all levels of price and preference. For a given problem, a dentist can often offer various treatments, at various price levels, but all equally beneficial to the patients health.

Brad May 3, 2006 at 8:16 pm

The idea behind public health is that everyone should be given the same level of care. That is why, here in Canada, we have a universal system.

Private systems are driven by one thing. Profit. This is why offering doctors the chance open their services to the market problematic.

The startup of 'for-profit' healthcare will suck doctors and nurses out of an already stressed public system. Not only that, but maybe the best doctors will switch out of the public system in search of a bigger paycheque (i would), furthering a disparity of care in a two-tiered system.

If you believe that all people deserve equal treatment, then the idea that we should be able to pay for healthcare is dangerous, since we have a growing gap between rich and poor, and the market only guaruntees quality of care for the rich.

And we do have two-teir cars, they are called buses, that's what we pleebs use to get to work.

dj superflat May 3, 2006 at 8:57 pm

the notion of equal medical treatment is ridiculous. first, market economies are based on inequality — you get what you can pay for. second, equality of medical treatment makes little sense due to the differences in people's conditions, needs, etc. and calling it equal access is equally silly (giving someone with a cold the same access as someone with cancer is not equal access at all once you take into account the severity of the problem).

donny May 3, 2006 at 9:15 pm

"An already stressed public system" is exactly the problem the free market wouldn't have allowed.
If you believe all people deserve equal treatment, why don't we throw our doors wide open and allow all people in the world free access to Canadian healthcare, at no cost? How many in need of healthcare could we reasonably care for? What makes Canadians so deserving compared to those living in poor countries?
It's not a matter of offering doctors a chance to offer their services to the market, it's a matter of not usurping their freedom to offer their services to the public.
If you believe people deserve equal treatment, why would you jump at the chance of a better paycheque, but deny that opportunity to a Doctor?

Mike May 4, 2006 at 8:26 am

"The idea behind public health is that everyone should be given the same level of care. That is why, here in Canada, we have a universal system."

Even if we grant that this is desirable (which for many reasons I believe it is not), this says nothing about the free-market system being inferior to your system. The two-tiered system in Canada still exists as my best friend is a doctor on the border near Toronto in the U.S. and makes most of his money from Canadians coming across the border.

In any case, the problem you mention is simply reconciled by providing the poor with incomes so that they can choose to purchase medical care if they want. Your proposal is like cutting off Tiger Woods' right arm to make a golf match between me and him fair. Why not give me a few extra strokes?

Dean May 4, 2006 at 8:27 am

I do think the reader's question was primarily based on a values issue, as Brad said, in that some people simply believe that health care is a commodity that all consumers should have equal access to, and thus that part really is unanswerable.

A more compelling argument might be for the externality associated with preventative health care: my preventing myself from catching the latest bug benefits everyone around me, in that it reduces their chance of getting sick.

Scott Clark May 4, 2006 at 9:52 am

Who was the first economist to write about the externalities argument as a reason for government intervention? If I had to guess, I'd say that economist was on the government payroll or at least hoping to get on a governement payroll in the near future.
That argument just never held much water with me, as all the goods and services that people say have positive externalities and need to be subsidized, most often education and healthcare, have such overwhelming internalities that they would get produced in spades no matter what, i.e. it pays to know how to read, or there are strong incentives to seek medical treatment and preventative care.
And even if there are postive externalities, when the government provides the good or service or subsidizes its production, the government creates such mis- and disincentives that must cancel out any of the external benefits that were supposed.
The same goes for information problems, public goods "free rider" problems, and any other pretext used to justify government intervention, they just don't measure up in my estimation.

Aaron Krowne May 4, 2006 at 10:09 am

There is one, and only one problem with the health care system in the US. This feature makes the system unique amongst developed countries, and is responsible for our almost cartoonish runaway health care costs and declining quality of coverage.

This feature is the employer-based tax treatment. It basically eliminates free choice for the health care consumer and buries the costs of overall health care coverage.

The bulk of health care consumers do not see much of the costs of the care they seek, so they seek more. Health care providers do not actually have to conduct the payment transactions with consumers, so price is not a factor (indeed, it almost never is even discussed). The insurance companies then respond to higher care charges by raising premiums and lowering coverage. Employers respond by taking more out of employees paychecks.

But this just subverts the negative reinforcement, so the whole process repeats, at a higher level of waste (and pillage by the health care system).

Suspiciously, the tax treatment responsible for this is new (created in the mid-90s), just about the time the runaway costs started appearing.

Any truly free-market or state-based system is better than what we have. Our system is a collosal error of maldesigned incentives. It'd almost be comical that the government could have made such a mistake, if it wasn't costing me thousands of dollars per year.

Here's another recent study on how out-of-control and dysfunctional the US's system is:

http://www.sptimes.com/2006/05/02/Worldandnation/Money_doesn_t_buy_us_.shtml

And here's a more detailed article I wrote on the structure of the problem:

http://br.endernet.org/~akrowne/writings/us_health_care/us_health_care/

When apologists point out how great our system is at curing cancer and how great treatment is in general, they're missing the point. The question is not what we're getting, its how much its costing us.

Half Sigma May 4, 2006 at 10:37 am

We don't have free market healthcare in the U.S., we have socialist healthcare pretending to be free market healthcare.

Most consumers get healthcare services for free (at least that's the way it seems to them), and compensation for doctors are set by the government (the Medicare rates are pretty much the standard).

Get it? Free healthcare plus government setting the compensation for doctors, that's socialism.

Dean May 4, 2006 at 11:06 am

Scott: I do agree that in this case, there is a large private benefit, but, given that demand is not perfectly inelastic, the difference between total social benefit and private benefit does mean that these health services will be underprovided by the market. While this does not mean that they should be completely government run, certainly a Pigouvian subsidy, in which the public (through the government) pays individuals for the benefit the public derives from the individuals' purchase, would be in order.

This is, of course, theoretically speaking. In reality, I agree that a relatively small externality (if it is indeed small) pales in comparison with the cost of implementing such a subsidy, and there is the usual problem of estimating the social benefit. Further, I agree that many things subsidized on the basis of positive externalities are a bit ridiculous, but I believe that the claim of an externality, at least in terms of preventative health, is a valid one.

Bill May 4, 2006 at 1:19 pm

I just wanted to note that "private means of certifying the quality of physicians" have, in fact, already arisen. The states license "physicians and surgeons." The medical specialty boards that certify specialists are private entities, and the hospitals that control what individual physicians can do within the instituion are a mix of public and private entities. The official, public, regulatory scheme is the barebones on which a very complicated private certification process is based.

Kebko May 4, 2006 at 1:21 pm

I will contend that a market cannot exist in health care because a free market requires the free will of 2 participants in a willing transaction. But the consumer in health care is frequently under duress purely as a result of needing the service. A contract entered under duress is null & void & not enforceable (I'd love to see someone take this argument to the courts). So, there is no way, in my mind, that an ambulance can take me from an accident scene to a hospital for treatment, where they can work on me & bill me for the services.

Even in less urgent matters, this problem makes a market difficult. For instance, I recently had pressure in my forehead that we couldn't get a diagnosis on. I decided to get an MRI & found out that it cost me a whopping $1,000. Now, how do I come to an expected value for that service?

Chance of pressure being from deadly brain cancer = 1%

Cost to me of having undiagnosed brain cancer = $1,000,000,000,000,000

Net Expected Cost of missing MRI scan & leaving deadly brain cancer in my head = 1% x $1,000,000,000,000,000

Well, I guess I'll take that expensive treatment, doctor.

I think this problem lies at the heart of why universal coverage is something that seems reasonable, and why we have to use an insurance based 3rd party payer system even though it totally screws up the market for health services. I don't know how to fix it, but the idea that health care can exist in some form of functional market misses the mark, I think.

Randy May 4, 2006 at 1:58 pm

Imagine that the US does go to a universal health care system. Those with sufficient resources will still demand high quality care with no waiting as opposed to the system everyone else has to use. The only difference will be that they will travel out of the country to get it – Bermuda or Thailand perhaps – which is also where all the best doctors and research money will go. The net result of universal health care will be a decline in the quality of health care available for the middle class to something like the standard of care currently provided to lower income people now – emergency room only and long waits. Create a system that runs on tax dollars, and eventually that system will have nothing but tax dollars to run on.

anon May 4, 2006 at 1:58 pm

"The idea behind public health is that everyone should be given the same level of care."

That being "mediocre"?

Morgan May 4, 2006 at 2:18 pm

Kebko:

I agree that there are circumstances under which we do not have a choice of suppliers. Your MRI example is not one of them.

When I'm having a heart attack, there's no time to comparison shop, nor am I in any condition to communicate that I'd like to be taken to the hospital 6 miles away rather than the one 1 mile away because it costs 75% less – even if I've thought about it ahead of time.

On the other hand, I can shop around for an MRI.

Expected value doesn't enter into it in either case, except that I might decide that the |EV| of an undiagnosed brain tumor isn't great enough to justify the price of the MRI. On the other hand, if I'm having a heart attack, I'm not even in a position to say "no" when I get there. They could charge me more than the expected value, and I'd be on the hook.

By chance, I was looking into the cost of an MRI in town this morning. $380.

Aaron Krowne:

Interesting article. Thanks.

kebko May 4, 2006 at 2:50 pm

I have 2 responses, Morgan:

1) The cost of any specific MRI probably depends on exactly what they are doing. I don't think it's a single price point.

2) My point on the MRI wasn't about shopping around. If the cost of an MRI was $5,000, and there was no way anybody could provide it for less, it would still be a decision that would be very difficult to quantify. The question still would remain, would a $5,000 treatment be worth it in order to make sure I don't have a 1% chance of terminal illness? We can forget this specific anecdote. In a "market" system, there will continue to be new services costing thousands of dollars that the consumer would have to evaluate for diagnosis. I can't put a price on the cost of dying, so how do I evaluate which services I welcome the market to offer me.

iceberg May 4, 2006 at 3:22 pm

Kebko,

It sounds like your MRI or heart attack cases are predicated on the existing scarcity of doctors to treat those illnesses.

The answer is not universal healthcare, but rather eliminating the government induced scarcity, and hence having more practioners compete for your busines in these fields, which will accomplish the most to drive down costs to the point where access to these and other expensive services will be trivial to even the poorest among society.

Also, any person sufficiently motivated to care about the costs associated with maintaining his health, will shop for an insurance agency to be there for him monetarily when he can't do the comparison shopping himself. Moving towards universal healthcare will do the opposite, namely disassociate the costs from the user, creating the moral hazard in which the user cares even less about maintaining his health.

kebko May 4, 2006 at 3:53 pm

I think you guys are still missing my point. The market will continue to offer marginally better services at higher costs, even if competition drives existing costs down. The value of not dying is infinity. So, if I develop a new treatment that costs $100,000, but doubles your chance of detecting a cancer you might have, it's still less expensive than the chance that you may die. So, suppliers have a market for any new methods they can come up with, with a more-or-less non-existent demand curve.

So, market forces will drive these prices down, while ever more expensive products with marginal benefits will be found. The effect is skyrocketing health costs over time, so that we have this complex, useful economic system that we all live under, until we find need for certain medical services, and then we have the option of facing expenses that dwarf the rest of our economic activities, or going without treatment. This is already happening to an extent.
You may say that this is a rational market behavior. If not dying is so much more important than any other transaction we may make, then maybe it should cost us an ever larger portion of our income. But, my point is that this is a decision made under duress, so that the basis for a rational market decision does not exist in the first place.

bbartlog May 4, 2006 at 4:21 pm

I don't agree with your assessment that high stakes imply duress. Duress is usually taken to mean threat or coercion and is legally distinguished from necessity. Check it up on Wikipedia for the generally accepted definition.
I also believe that your claim that your life is infinitely valuable to you (or more generally, that people value their lives extremely highly, say in excess of ten million dollars) is at variance with observed human behavior. For example, driving ten miles carries a risk of death of perhaps 1x10e-9 (I am lowballing), which in combination with your claimed value for your life would imply that you would not be willing to undergo such a terribly risky endeavor for less than a million dollars. Throwing around lots of extra zeros in an attempt to make the point that life is precious adds nothing to your argument.

liberty May 4, 2006 at 5:00 pm

>So, market forces will drive these prices down, while ever more expensive products with marginal benefits will be found. The effect is skyrocketing health costs over time

No, because you are missing one major factor.

Do we have skyrocketing technology costs? No. They are falling. Is it because demand is low? No. It is because the new expensive products come on line and the rich buy them, but the poorer people sometimes stick with buying the cheaper ones, and the new ones existance makes the old ones way cheaper. So, in the case of a new cancer drug, everyone may go ahead and buy the more expensive one and go into debt, but in the case of new flu vaccines that you can spray instead of inject and new anti-depressants and erectil disfunction and cholesterol medications and diet pills and generally any non-emergency, non-life threatening diseases, the poor can stick with last year's medicine until next year; while the richer folk buy the new stuff and help pay off the patented investment costs.

In this way, as is seen in luxury markets, the rich subsidize the poor, and get to have the super-neat new stuff first.

iceberg May 4, 2006 at 5:02 pm

kebko,

You still have not addressed why you believe that everybody is entitled to the services of doctors without directly paying their costs.

Inquiring minds wish to understand how the existence of high-cost treatments create the moral imperitive to rob unwilling tax payers to fund those who can't afford these services.

kebko May 4, 2006 at 5:04 pm

Good points. Maybe I stuck a few too many zeros on there. ;-)

quadrupole May 4, 2006 at 6:58 pm

Morgan,

As to your heart attack example. In my local area there are advertisements (radio and tv) paid for by hospitals here that have emergency heart centers. They are actively advertising to pursuade you to go to *them* when you think you are having a heart attack rather than to some other, potentially closer, hospital. Are they simply wasting their money, or are consumers capable of making choices about the hospitals to go to *in a serious emergency* based on perceived quality of care? If so, why not based on price?

quadrupole May 4, 2006 at 7:37 pm

I am going to make a VERY, VERY un-PC point. The value to *you* of *you* dying is infinite. It is unquestionably quite finite to society. The evidence of this is that absolutely no one advocates expending infinite societal resources on anyone.

Society has a general way of expressing to you how much it values you (and your contributions to society). It does so by paying you, or paying someone who cares enough to voluntarily support you. When a treatment costs more than you can afford it means that the treatment costs more than you contribute to society. Or to put it differently, society values what you contribute less than it values the resources going into providing the treatment.

Since we are all *VERY* uncomfortable with assigning value to human life (and health), and even less comfortable with assigning that value based on what people earn (or the earnings of those who care enough to voluntarily support them) we have a tendency to to try to separate consumption of health care from earnings. We in essence want to say: everyone's contributions to society are equally valuable.

But this simply isn't true. The value to society of a cardiologist is vastly greater than the value to society of a fast food restaurant worker.

What happens when you try be willing to expend equal resources on all members of society, independent of the value they contribute is that you very quickly discover that you don't have enough resources to care for everyone at the same, top level of care. So you lower the level of care until you an afford to provide it to everyone. The result is that you loose some of the contributions of the high contributing members of society by under caring for their health, and you end up spending more on the low contributing members of society than they have contributed. In short, society as a whole is made poorer economically.

It may be that this is the road we want to travel, but we should travel it with our eyes open.

Strophyx May 4, 2006 at 9:01 pm

The idea that the value of life (i.e., avoiding death at this particular moment) is only infinite or even astronomical for those living in a a dream world. People implicitly assign a value to it everyday when they choose to accept dangerous jobs or not to spend their money on optional safety devices. The problem only appears when we start talking blithely about some mythical sugar daddy (e.g., insurance companies, the government or "the health care system") providing these things for us.

As for the complexity of medical decisions, I doubt that the FDA or similar "official" bodies provide anything that's any better (or even as good) as what's provided by the little UL label on those "complex" electronic devices we all purchase.

Morgan May 4, 2006 at 11:49 pm

quadrupole:

Are they wasting their money? I guess that to the extent they are reaching people who a) will never believe they are having a heart attack, or b) pass very quickly from believing they are having a heart attack to being unable to communicate their preferences, yes. But then, some people die before they have a chance to purchase my widget. Damn the luck.

I was simply pointing out that there are some circumstances under which we are incapable of making decisions – not that those circumstances are the norm.

Randy May 5, 2006 at 11:42 am

Quadropole,

You're right, that was very un-PC. And very well said!

Morgan May 5, 2006 at 12:46 pm

quadrupole:

Are we treating "everyone's contributions to society are equally valuable", or treating everyone as if they have some minimum inherent worth regardless of their actual value to society?

In the first case, the impulse should be to move as far toward total redistribution as necessary – to each according to his need. In the latter, redistribution would be capped, as long as the inherent worth is much less than the average actual value.

I guess it's a distinction without a difference as long as no one puts a hard number to inherent worth.

Aaron May 5, 2006 at 2:13 pm

You cannot "shop" for an EMS team when you are face-down in the kiddie pool. That makes it different than other goods and services.

quadrupole May 5, 2006 at 2:45 pm

Morgan,

You are completely discounting the vigilant spouse. My father has tried three times to have a heart attack (thankfully unsuccessfully). He didn't have a heart attack because when he began exhibiting early symptoms, my mother recognized them and got him to medical treatment, thus preventing the heart attack. There is ZERO question my mother would have choosen a heart emergency center if she'd known about one. She's precisely who the ads are targetting. Likewise, when you are face down in a kiddie pool, it's frequently your loved ones around you who call the abulance, and arrange getting you to emergency care. It's astounding how much space for choice there potentially could be there. For example, if you had a loved one with a tramatic injury, would you direct the ambulance to take them to the regional trauma center, or the nearest hospital if the difference in transit time where small?

There is TONs of room for consumer choice, even in emergency situations.

quadrupole May 5, 2006 at 2:45 pm

Morgan,

You are completely discounting the vigilant spouse. My father has tried three times to have a heart attack (thankfully unsuccessfully). He didn't have a heart attack because when he began exhibiting early symptoms, my mother recognized them and got him to medical treatment, thus preventing the heart attack. There is ZERO question my mother would have choosen a heart emergency center if she'd known about one. She's precisely who the ads are targetting. Likewise, when you are face down in a kiddie pool, it's frequently your loved ones around you who call the abulance, and arrange getting you to emergency care. It's astounding how much space for choice there potentially could be there. For example, if you had a loved one with a tramatic injury, would you direct the ambulance to take them to the regional trauma center, or the nearest hospital if the difference in transit time where small?

There is TONs of room for consumer choice, even in emergency situations.

quadrupole May 5, 2006 at 2:46 pm

My apology for the duplicate post

Aaron May 5, 2006 at 2:59 pm

Quadrupole, like I said, YOU cannot shop for an EMS team when YOU are face down in the kiddie pool. That is a significant difference. Glad to hear your dad was taken care of.

liberty May 5, 2006 at 3:20 pm

I would like to repeat my point that when we are discussing overall health care costs and health care solutions, the emergency situations are also a small percent.

quadrupole May 5, 2006 at 3:27 pm

Aaron,

My point is no one face down in a kiddie pool is either shopping for or seeking an EMS team :) If someone else doesn't do it for you, you are going to drown.

kebko May 6, 2006 at 3:15 am

Iceberg – You make valid points. I think there is a problem with forcing some people to pay for other people's services.

I'm just making the point that the nature of health services doesn't lend itself to a functioning free market. That's why nobody is willing to operate in a free market. Some people don't have insurance, and they go to the hospital when they absolutely need to, and the hospital treats them knowing they aren't going to get paid, and we pay for it in one way or another. Others get insurance because we know that when we have a problem that is truly life threatening, we would most likely be willing to ruin ourselves financially in order to get that service. And I don't think anybody would suggest that the 3rd party payer system that we have is remotely rational or that it leads to a functioning or rational market (where consumers can freely purchase a personally acceptable amount of the service over time). I'm suggesting that, for starters, this problem is the product of a combination of (1) the mortal threat the need for the service can pose and (2) the unlimited number of ever more expensive, marginally more effective services that can be provided to combat that mortal threat.

(The point isn't whether you can shop around or not. The point is that new services, no matter how high the true cost of the service, will always find demand – especially since our avoidance of a fee-for-service market leads us into 3rd party payer systems.)

So, yeah, socially centralized systems are morally challenged. But, our behavior in the current system suggests to me that this isn't a service with a functioning market solution either. I don't know that I have the answer – I'd love to rely on markets, but I think the answer has to lie a little bit beyond that.

Flash December 20, 2006 at 2:40 pm

We already pay for basic healthcare. We pay enough to care for everyone to a reasonable degree … already.

The U.S. has the highest taxation rate of any country on the planet WITHOUT including some type of basic healthcare in that taxation.

Many people pay nearly 50% of their income in taxes. (some pay more when all is said and done)

The fact is that we already pay enough to extend basic emergency (and even non-emergency) healthcare to everyone.

The fact that the government squanders it at the behests of lobbyists and special interests is something over which we have relinquished control.

If people were taxes less, and government spending were sane, most people could afford healthcare out of their own pocket.

Annual taxes at the different levels far outweigh that of what even the best health insurance premiums would be.

Rain May 10, 2007 at 2:58 am

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