1. The fire department analogy seems to imply that all medical expenses are for emergency situations, which isn’t even true for emergency rooms. (Need to find reference for this…)

Incidentally, for-profit ERs do exist. Also, have you heard of Carol.com, a regional website where consumers can price compare for medical services?

2. “When their lives depend on it, our citizens deserve to have a system where share prices and profits aren’t a concern.” Is this the case for food and shelter, too? Would people prefer a government-run agriculture and housing?

Whom do they deserve such a system it from, and who determines this? What happens if those chosen to be the providers in such a system peacefully refuse to cooperate?

3. “The fire department isn’t going to try to squirm out of their duty by screwing you with some loophole in the contract – just so they can please their shareholders.” To close the loop on the analogy here, may we substitute “fire department” with a government-run medical care system? If so, are you saying that in such systems people are never denied care? A beg to differ.

I read Mr. Goodman’s article when he wrote it and I referenced it in one of my articles HERE on 5/4/2007. (Doing the Google search you recommended, my article comes up as the #4 result) I later referenced it again in another article (6/28/07) where I basically say that the Govt would actually need to pass a law like that because HSAs aren’t going to take hold unless people first get some transparency in the so-called “health care marketplace.” (sorry about the quotes)

I think my fire department example was more precise.

• The firefighters can save your life in that fire.
• The fire department isn’t going to try to squirm out of their duty by screwing you with some loophole in the contract – just so they can please their shareholders.
• If you have a fire in the kitchen of your mobile home and replace the kitchen, then move to another municipality – the new fire department won’t try to get out of having to respond to a fire in your kitchen by saying it has a pre-existing condition.

(That last one was really creative. But if you know anything about the individual health insurance market, it’s dead on)

There is a reason even the most conservative people in this country don’t have a problem with the socialist nature of our police and fire departments. When their lives depend on it, our citizens deserve to have a system where share prices and profits aren’t a concern. Police and Firefighters can just do their best to serve you.

If your house burns down and your homeowners insurance company screws you out of paying your claim because they have more expensive lawyers, you’re atleast able to keep fighting it (supposing the fire department got you out safe). If you’re barely conscious in a hospital room and the health insurance company squirms out of covering your life saving operation, you’re in a different situation.

I appreciate your thoughtful response.

We mean different things when using the term “free market.” First, I do not use it in quotes (well, except for in cases like the above). I don’t get why people do that, as I’ve seen it before.

You write that a feature of a free market, perhaps a defining feature, is that one “can go shopping to compare the quality and price of goods and services to determine my vendor of choice.”

I define a free market to be one where individuals are free to exchange goods and services (a market) without government prohibiting or forcing some kinds of transactions. How I use it resembles what I found at dictionary.com. Not that dictionaries are authoritative, rather, they reflect common usage.

Regarding the inability of finding prices of medical services, I think this is a product our government intervention in the market. A few days ago I read a blog post by John Goodman about HSAs and transparency. If the link didn’t work, Google “HSAs Explained” and “John Goodman.”

He writes: “Suppose we passed a law tomorrow prohibiting all insurance companies (including Medicare and Medicaid) from paying any medical bills less than $5,000. What would happen? The medical marketplace would transform almost overnight. Within a couple of months, there would be no such thing as a primary care physician (PCP) who did not post prices – at least for routine procedures. …”

Not that he’s advocating such a law, but I think he has a good point, and I recommend the rest of the post.

Your analogy of emergency medical care to police and fire services. The analogy, as I understand it, is that one’s house burning down is analogous to having a medical emergency. Since fire departments tend to be municipal, hence, government run, and people commonly accept it, then health care also be government-run. Or put another way, the devil’s advocate is saying that if one advocates a free market in health care, one would advocate a free market in fire departments, which is supposed to sound absurd.

But I think a proper analogy needs to be more precise. The fire department puts out the fire. It does not pay for repairing the damage done by the fire. That’s why people by homeowner’s insurance, which we do have a relatively free market in. So in this context, homeowner’s insurance is analogous to medical insurance. Also, the fire department is analogous to emergency medical services (EMS), which can be both non-government or government associated, or associated with hospitals.

As a person with health insurance, I can’t compare prices on health care services because the health insurance companies need to make the negotiated rates they have with providers proprietary. Even without the health insurance companies making things complicated, there is no way to shop for health care. I tried doing this recently. The provider came back and charged me over 5x their original estimate.

In that case, I found out there was no oversight for the way the provider runs their business (like the Colorado Division of Insurance oversees health insurance companies). The Colorado Board of Medical Examiners would only look at quality of care, over-utilization of testing, etc. They don’t have jurisdiction regarding fee disputes between a patient and a practitioner – nobody does. And I found out that medical providers could give a crap about a complaint to the BBB.

Sometimes you’ll even get certain products from a provider and find out later that that those products were actually from a different provider that wasn’t “in-network”.

Even then, it would have been hard to go shopping for a better deal on crutches and a brace when I woke up from my knee surgery.

Say that someday we accomplish complete transparency in the health care market. If you’re at my house having dinner and have a heart attack and collapse unconscious on the floor, I’m calling 911. You’re not going to be in much shape to make your own decisions about the care you receive or the providers you receive it from.

Can you see how a devil’s advocate could make a similar case about police and fire services? Would you be in favor of free market fire protection instead of the current “socialist” system we have now?

I suggest looking at how existing government controls over the free-market in health care have contributed to prohibitively expensive insurance. The website FreeMarketCure.com is a good start.