Information asymmetry and uncertainty take out informed choice
Gaffney et al 16. From the Division of Pulmonary and Critical Care Medicine (Dr Gaffney), Massachusetts General Hospital; and the Section of Pulmonary and Critical Care Medicine (Drs Verhoef and Hall), University of Chicago. 07/2016. “Rebuttal From Drs Gaffney, Verhoef, and Hall.” Chest, vol. 150, no. 1, pp. 14–15.
A free market for health care is not only undesirable: it is, as economists have noted for decades, a fantasy. Fundamentally, the degree of information asymmetry between the buyer (the patient) and the seller (the provider) prevents health care from conforming to the theoretical tenets of free-market economics. Kenneth Arrow famously contended that the uncertainty intrinsic to health care makes it unique from other goods and services.5 The health economist Bob Evans has argued that not only has there never been a pure free market in health care but that “inherent characteristics of health and health care make it impossible that there ever could be.” 6 On the contrary, he argues, attempts to inject market mechanisms into health care are fundamentally about redistribution. As health-care costs are shifted from public to out-of-pocket sources, those with higher incomes invariably benefit. The US divergence from other high-income nations is a disaster. We contend with uninsurance and underinsurance, a lack of coverage for critical benefits, worse outcomes, and higher overall costs. As others have noted, the savings made possible through a single-payer system7 would allow extension of health care as a social right to the entire nation. In contradistinction with a fantastical health-care free market, such a program is both attainable and desirable.