The storyline goes something like this: the President believes in "consumer-driven" health care whereby people save their own money in special accounts that they can use to pay for health care. The theory is that if citizens are actually encouraged to pay for their own health care costs directly - instead of through a third party insurance company - they will make more rational decisions about which procedures/tests/exams to have, and which not to have. We are led to believe that adding that supposedly "free market" force to the health care system will result in major cost savings for the entire system.
Look, there are a lot of areas where "consumer-driven" forces have played a terrific role. Take car insurance and mortgage rates - the Internet has allowed people to compare different rates and plans, creating more competition, and some downward pressure on prices. But that has only worked because insurance and mortgage rates/plans are fairly standard and can be understood by the average consumer with a little research.
The same, obviously, cannot be said about medical decisions. A consumer cannot possibly be expected to know what services to buy and not buy. There's a reason, after all, that doctors have to go to school for years and years and years before they are liscensed to treat people and make medical decisions for patients.
Thus, it is very likely that the end result of Bush's drive to expand Health Savings Accounts instead of expanding health insurance coverage will be worse medical coverage for millions of ordinary citizens, and no end to the private health care industry profiteering that has ravaged our system. Strapped for cash already because of stagnating wages, many will try to skimp on their own health care expenditures, unable to know whether they are making a bad medical decision that will affect them over the long haul.
The bottom line is simple: free market orthodoxy does not work in markets that can't be free. And health care can't be a free market, because one of the key characteristics of a free market is that consumers have a minimum level of substantive information to make informed choices. And unless President Bush is proposing sending every American to medical school, his health care proposals will only make the health care crisis worse.
Originally published at Sirotablog