Consumers play a limited role in the transaction. They don’t negotiate price. Decisions about care, diagnosis, treatment, prescriptions, etc. — these are handled primarily by the doctor. Selection of doctor, referrals, etc. are controlled by the terms of coverage. And coverage is negotiated by employers and their agents, on behalf of their employees, with coverage ‘bundled’ in with salary and other aspects of the overall position. Healthcare is not even close to a free market.
I think I’m in favor of a patient-pays approach for routine matters, backed up by government provided universal coverage for catastrophic matters above a certain level. If government handles catastrophic, there is no need for insurers. A change like this would transform the economics of the field and result in enormous savings. Routine expenses could be funded from some sort of healthcare savings accounts.
Also, intellectual property in this country is a scam, and current practices should be gutted. The US taxpayer pays for the majority of medical research in this country through grants to Universities and the like. Big Pharma enters the process downstream and is a recipient of major taxpayer subsidies in this respect. Pharma’s ‘rights’ in the resulting medicines should be reduced and competition encouraged through the support for generics and imports.
