The Democratization of Health Care:The Case Against Individual Retail Transactions

Many of us would like to disavow it, but the federal government, with all of its dissonance, is a walking manifestation of our collective voice -- 130 million voting Americans (last presidential election) pulling in as many different directions. When we look at the resulting odd misshapen creature (Congress, the Executive Branch, the Supreme Court) that bears no resemblance to any idealized notion of America, it is easy for each of us to see government as a foreign, unresponsive, intrusive entity stumbling around in pursuit of our best interest.

It is this noisy, confused, tripedal creature that has assumed control over the medical market. There are those who cheer in glee that the people, through their elected representatives, have finally stepped in to ensure that all Americans have access to affordable health care. And at the other extreme, there are those who want to wrest control away from government and create a market of individual, medical retail transactions that exist with little government interference. In the middle lies the vast majority who couldn't care less about market structure and the role of government. Their first and really only concern is to have access to the health care they need, when they need it, at an affordable price.

My personal sympathies always lie with individual choice; group think, group action, particularly when it is mediated through government, is a worrisome thing, because inevitably, though it tries hard not to be, government is a clumsy oaf that tends to trample on the preferences and needs of the few. I would add to that concern the troubles that eventuate, as in the case of medical care, when government presumes to decide purchasing preferences -- to choose product winners or dictate consumer consumption patterns.

There is something that is perceived as downright un-American about government playing such a dominant role in the health care market; but the truth is, we can't do otherwise. Here is the conundrum: no one has devised a compensation plan which would allow a medical market to be built around individual retail transactions. Which is not to say that there have not been serious proposals (e.g., health savings accounts, vouchers) put forward to allow consumers to purchase medical products and services as they do automobiles or computers. The consumer has reviewed each one of these ideas (Medicare insurance for government vouchers, or private insurance for savings accounts), and they easily recognize their flaw -- at the moment of need, health savings accounts, vouchers and the myriad of similar products will fail them, because the risk pooling feature, the essential of insurance, is limited or nonexistent, and so the individual consumer does not have the security to be found in insurance.

So to my friends who hate collective purchasing (and I use the word collective to spur them to action), it is incumbent upon you to find a solution that will allow the individual consumer to have the security and access to the same level of health care that can be gotten through some form of insurance. My best guess is that no such system can be devised. It is the risk pooling effect of insurance that powers the health care market in this country. This market fundamental will not stop some from yelling about "socialized medicine," but the fact of the matter is that to build and maintain affordable medical care, we must buy collectively through either private insurance or government social insurance.

The market dictates the rule. I am presenting it here as an axiom that someone will need to falsify to the satisfaction of consumers before a market of individual, medical retail transaction can prevail.