We’ve had that conversation before too. Sounds good in the abstract. Let’s consider what it would really look like. First principle is that if you don’t have insurance, can’t afford it, or can’t convince a bank that you’re good for it, you can’t buy it. Fine if it’s a car. A little thornier if it’s a stent for a STEMI. Don’t worry - I’m sure the free market would respond with companies standing by 24/7 to assess your hard assets and buy them from you for 50% of their value, and have the money in an escrow account for the hospital within 30 minutes. Shame about that retirement you were hoping to take soon. Back to the grindstone for another 30 years.
The perfect free market still doesn’t do anything to improve preventive care. In fact, since it will all be cash out of pocket, how many poor families are going to choose groceries and gas money over vaccines for their kids?
Oh but charity care will step in - nah, they’ll be too overloaded trying to save all the pediatric cancer cases who can’t afford their chemo. All the single parents who’ll die if they don’t get their gall bladder out.
And let’s not forget the granddaddy of all problem legislation for a true capitalist healthcare society: EMTALA. What
raging socialist signed that bill? If a homeless guy who smokes 2 packs a day and eats fast food from the dumpster wanders into the ER having a STEMI, guess what, he gets a free ticket to the cardiac ICU! A free set of stents or maybe even a 4 vessel CABG. When that goes south, he’ll get an intraaortic balloon pump. When that plus the bypass plus all the drugs he’s done shut down his kidneys, he’ll get CRRT. The finest healthcare in the world. Millions of dollars of it. Who foots the bill? Currently he’d get emergency Medicaid and the government would step in. Maybe that’s not a great idea and we should put a little more thought into which lives are worth saving. But who gets to make that call? Are you comfortable if that ends up in the opposite political party’s hands?
So let’s repeal EMTALA. Free market all the way baby! Oof, speaking of babies, hope you’ve got a lot of cash on hand, or maybe a convenient manger nearby if you’re about to have one. If you need a c-section and can’t afford one, I guess you’ll just have to go really old-school and die instead.
But enough about that, let’s consider these medical miracles that we have in the US, and where they came from. Trillions of tax dollars over the course of the past century have been poured into medical research, medical education, public health. Sure, the blockbuster drugs were funded by big pharmaceutical companies. But the basic science they were based on was overwhelmingly directly or indirectly government funded. And most of it probably sounded stupid at the time. That’s the nature of basic science research. Why did the NIH pay some people to test the effects of
lizard spit on pancreatic enzymes? What a massive waste of taxpayer dollars, right? This is your money, people!
I forget whether you’re anesthesia background. Ever watched a CABG? Loooot of expensive equipment and expensive people in that room. Not to mention several days in a cardiac ICU afterward. What will hospitals do when only the wealthy can afford this amazing care? CTS, Onc, transplant, rheum, and certainly pain management. Those service lines will shrivel up like a balloon on ice. They’ll be scrabbling like cats over the few customers who can afford to shell out $20,000 for medical care, not knowing if they’ll need it next week for a car accident or a ruptured appendix. Private medical insurance will prevent that? Sure, as long as you’ve never been sick before. Employer-sponsored healthcare? That’s a result of government interference too. Hopefully you can buy your own. Better watch out though because if they get wind that you’ve got cancer, oops, they’ve just coincidentally decided not to renew your policy.
The system is complicated and messy. No solution is prefect. But I don’t think one that leaves millions of people dying in the street is the right call.