Today, David Brooks asks whether or not markets function well in the American health care system and he seems to think that, when it doesn't, it's largely because health care providers know so much more about health and wellbeing than health care consumers:
As you know, the American health care system is not like a normal market. When you make most health care decisions you don’t get much information on comparative cost and quality; the personal bill you get is only vaguely related to the services; the expense is often determined by how many procedures are done, not whether the problem is fixed.
You wouldn’t buy a phone this way.
The real issue is that you don't buy a phone because you are experiencing intense pain and discomfort and believe that the purchase of a phone would make the pain go away. Buying a phone would be like buying health care if and only if somebody twisted your arm out of your socket and agreed to let go and reset you if and only if you present your credit card to the AT&T store.
Health care transactions are almost all performed under duress. Now, later on, Brooks says, "Patients on a gurney can’t really make normal choices..." but that's about it, and it's not even clear that he's talking about pain and discomfort here, he may mean that the patient has been anesthetized.
Maybe I'm weird, but I don't go to the doctor for every scrape, bruise or headache. I go once a year for a physical because it's the right thing to do and for a follow up if I am directed. If I show up sick or hurt, I am really sick or hurt. A limb has been damaged. The flu is so bad I had a hard time even making it to his office. Okay, I'll go in for a flu shot, but that's to prevent the pain that I know is coming if I don't.What I pay for such services is the functional equivalent of protection money.
When does the stock market not work? When people are forced to sell stocks against their will. A lot of the health care market functions as a market in crisis. In the stock market, it's sellers forced out. In the health care market, it's sufferers forced in.
Laser eye surgery produces more patient satisfaction than any other surgery. But it’s generally not covered by insurance, so it’s a free market. Twenty years ago it cost about $2,200 per eye. Now I see ads starting at $250 an eye.
Well, okay. The market functions, over time, for elective procedures. But let's not expect people to negotiate over serious, sometimes chronic conditions. Every time somebody suggests a market-driven health care solution, they are suggesting that patients negotiate with providers while under considerable duress. YIf you ever buy a phone that way, you're buying it from the mob.