“I document a large and mounting body of empirical research that shows that key market-based policies in health care have failed. Even if well intended, these policies have often not helped people make meaningful choices of medical care or insurance plans. And neither have they controlled spending, as experts promised.
In fact, they are doing exactly the opposite. They are setting people up to make poor choices and are scaffolding a massive, ineffective market bureaucracy.
One-third of people said they would rather file their taxes than read the terms of a health plan. And reams of studies summarized in my article affirm that people do not choose well among health insurance plan options, and these errors are hard to remedy with anything short of a strong default plan—in which case, one must ask whether “choice” even matters.
Likewise, even when people have to pay a large share of their own medical care and have easy access to price information, they still do not compare prices or choose the lowest-price options, even for services with little variation in quality. One partial explanation is that health care patients look to doctors—not price lists—to steer their care. Patients lack the desire, time, knowledge, and skills to navigate medical decisions as “consumers.”
The focus of the last several decades of health regulation has been to try to fix broken markets and flawed consumers through constant regulatory, technocratic tinkering—either to spur competition or to nudge consumers toward better choices. This tinkering has fallen short, and it has produced a massive market-based bureaucracy.
Thick layers of government regulations and regulators attempt to scaffold failing market-based policies. Plus, this scaffolding has deeply embedded private health care enterprises—with high profits and salaries—into the bureaucracy. As one example, the 2018 salary for the CEO of Blue Cross and Blue Shield of Michigan was recently reported to be $19 million, which is not an unusual sum among health care executives.
Because markets do not meaningfully enhance choice, do not avoid bureaucracy, and have certainly not solved cost problems, it is time to stop tinkering and to seek a better foundation for the next era of health policy and regulation.”
“It is time to give up the false hope that health care markets and individual purchase decisions will produce a health care system that Americans want and, in the process, drive down spending. Policymakers have spent a half-century avoiding the hard questions about what values, objectives, and tradeoffs should guide health policy, by hoping that markets would magically answer these questions.
The reality is that the only way to build effective health policy—and, in turn, health regulation—is by engaging deeply in these hard questions and the challenging political battles they necessarily provoke.”
High-Deductible Health Plans Reduce Health Care Cost And Utilization, Including Use Of Needed Preventive Services Rajender Agarwal et al. 10 2017. HealthAffairs. https://www.healthaffairs.org/doi/10.1377/hlthaff.2017.0610 Does High Cost-Sharing Slow the Long-term Growth Rate of Health Spending? Evidence from the States Molly Frean and Mark
“What’s irritating, though, is that many of the best free market ideas for helping working families have not been tried.
What would happen if we actually stopped providing tax incentives for employer-sponsored health insurance? Or if we allowed people to pick less expensive insurance plans that didn’t cover chiropractic bills and dermatology visits but did provide the kind of coverage they were most likely to use and would most likely cause them financial strain if they didn’t have? The annual savings for the average family from this type of policy change would likely surpass any child allowance.
What if we had occupational licensing reforms and allowed people to run small businesses out of their home without fear that the local health department will shut them down? These would give families another path to upward mobility.
What if we stopped making childcare more expensive through government regulations, such as demanding that daycare workers have unnecessary masters degrees and mandating child-to- staff ratios instead of just allowing parents to decide whom they trust with their children?
What if we changed zoning rules so that families could rent out extra rooms in their homes or allowed extended families to more easily live together? What if zoning rules didn’t keep residential properties so far away from commercial properties, in turn requiring that children be driven everywhere?
What if—and here is an idea whose resonance has become even more apparent in recent months—we had real school choice? What if parents didn’t have to worry about buying a more expensive home in order to get their children access to a better school district? Or what if we allowed them to choose a charter school or private school when the public schools in their neighborhood didn’t perform (or even open in person)?
What if instead of continuing to subsidize the bloated higher education industry, we simply offered flexible vouchers to low-income students, letting them spend the money in a way that would allow them to quickly and efficiently gain the job skills they wanted?”
“Last week, a restaurant owner in Seymour, Indiana, told her local paper that the city should restrict access to food trucks as a way to bolster business at her brick-and-mortar restaurant. She’s taken issue with a particular food truck owned by a national chicken chain.
“The days they were in town, we did have a considerable loss, and they had a line all day,” Lori Keithley, owner of Brewskie’s Downtown in Seymour, told local newspaper The Tribune. She claims Brewskie’s “can’t compete with Chick-fil-A.” So she wants the city to force food trucks operating in the city—including the Chick-fil-A truck, which went through the same licensing, permitting, and inspection process as other food trucks operating in the city—out of the downtown area.”
“some who can’t or won’t compete throw up their hands and ask the government to limit choice by stifling competition. That’s protectionism.”
“In the U.S., a botched and politicized COVID-19 vaccine distribution process seems to be fueling a black market in vaccines.
Anyone with knowledge of their fellow humans could have seen this coming. Limited supplies and controlled distribution of a product in high demand incentivize people to jump the line, or to make money by offering to help others do so.
“There absolutely will be a black market,” New York University bioethicist Arthur Caplan commented at the beginning of December. “Anything that’s seen as lifesaving, life-preserving, and that’s in short supply creates black markets.””
“In the end, federal promises of 20 million vaccinations administered by the end of the year were off by a lot, with the actual number just over 2 million.”
“Cochrane believes governments should have got out of the way of companies that could have sold people what they need to deal with the pandemic, including vaccines. “The government could buy too,” he offers, but “allowing the vaccine to go to the highest bidders—and allowing people to get it at CVS or administer it themselves—would have rolled vaccines out much faster.””