Consumer Choice Fails---Disease

Markets are good at allocating resources within healthcare but not at increasing the total resource pool to ensure total coverage.

Thomas W. O’Rourke 17. University of Illinois. 05/04/2017. “Lost in the Health Care Reform Discussion: Health Care as a Right or Privilege.” American Journal of Health Education, vol. 48, no. 3, pp. 138–141.

Health care for every citizen is just as essential, and making it a right would make it a public responsibility subject to public accountability, while largely being provided by the private sector, but the country has not yet committed to ensuring that all of its citizens have health care coverage. Nor does it appear that this is on the horizon. Unlike many other goods and services, laws of supply and demand do not function well with health care.7 Many proponents of repeal and replace often view health care as a personal responsibility and/or market commodity rather than as a human service and contend that reform should be based on utilizing the discipline and inherent efficiencies of a market economy approach. Markets can be effective and efficient in allocating resources based on ability to pay but are not intended to be equitable or fair. Markets are inherently unfair. That is what they are designed to do and do accomplish, with health care being a perfect example. Markets very efficiently determine who drives a Porsche, Toyota, or the cheapest car, the Nissan Vespa; who takes the bus; who rides a bike or walks but function less well in meeting basic human needs. With respect to heath care, markets also efficiently and effectively decide who does or does not get health care, who suffers illness or disability, who goes bankrupt, and, in many cases, ultimately who lives or dies. Despite recent reform efforts, U.S. health care continues to be primarily allocated by an ability to pay and not by need, with a “wallet biopsy” being the most common procedure, where the first question asked of us in seeking care is “what is your insurance?” What have been the results? Results of reform market-based initiatives have been less than impressive. Despite decades of attempts, costs continue to rise while consumer choice and access to provider networks decline. When compared with other industrial nations, in terms of access, cost, and health statistics, the United States is an outlier, and not in a favorable direction. We have the least access and by far the highest costs in the world, although we do not receive more physician services or hospital days annually.8,9 Nor are our health statistics anything to be proud of. Our health statistics, such as infant mortality or longevity, which were among the best a half century ago, are now among the lowest of industrialized countries.10 If the United States were in the Health Olympics we would be eliminated in the early heats—we would not get to the finals in any event much less get to medal podium.11 Said another way, in terms of health statistics, over the past several decades we have been “lapped” by many other countries.