Competition alone doesn’t prevent admin costs

We welcome this important debate, which is unfolding at a critical political juncture. Dr Berdine’s 1 counterpoint has usefully broadened our discussion beyond the issue of single payer to the larger question of the role of the free market in health care. Dr Berdine 1 argues that in an unhindered competitive health-care marketplace, the market will clear at a price and quantity of goods/services that, as if by definition, leaves all parties maximally satisfied. This argument is little more than a tautology that would, if possible, result in a health-care dystopia that society would not accept. Low income individuals might “choose” to spend their money on food instead of asthma inhalers. By Dr Berdine’s logic, this scenario is as it should be, and any intervention by government would only make things worse. Those dying of status asthmaticus might beg to differ, if they were able, as might patients with hypertension who suffer strokes because they elected to cover their rent instead of paying for physician visits. He argues that government involvement in the health care realm has “priced health care beyond the reach of the average person.” 1 It is a rather curious point, because the United States already has a relatively privatized and unregulated health-care system (compared with other high-income nations) while also having the highest costs.2 Furthermore, $375 billion of our expenditures can be attributed to wasteful administrative costs associated with our multipayer insurance market.3 Dr Berdine1 does make a good point when he notes that government-granted patent monopolies can result in high drug prices. To address this issue, a single-payer national health program would directly negotiate with pharmaceutical companies over drug prices. Indeed, the Veterans Health Administration pays 40% less for prescription drugs compared with Medicare, indicating that substantial cost-savings could be achieved by facilitating such negotiations.4