Why Does Free Enterprise in Healthcare Fail?

Free enterprise normally does a fantastic job of attending to our needs.  Need gas for your car?  Chances are good that there will be a gas station right there on the corner where you need it.  Need your car repaired?  Look in the phone book (or on the web) and there will be dozens of repair shop.  Look online and find reviews to allow you to pick a good one.  Need your pet groomed?  A day at a spa?  A stock broker?  A bagel?  A place to eat at 2 AM?  Chances are there will be someone who has already thought of your needs and spent many hours setting up a business to meet your needs.

So what is the deal with healthcare?  When you are feeling chest pains at 8 PM, your only choice is to go down to the emergency room, where you will pay a thousand dollars to the hospital and a thousand dollars to the physician the moment you walk into the back.  Want an aspirin?  That will be $10 – per pill!  Actually get admitted?  Better hope that you have a friend or family member who will stay with you and make sure the nurses give you the correct medication and to get you a glass of water when you need it, because the nurses will generally be hard to find most of the time.

Go into a nursing facility, and things get even worse.  No matter how long you are there, it will cost your whole life savings.  Nursing quality drops even more dramatically with patients left without care for hours and being treated like children rather than getting the respect they deserve.  Family members are afraid to say anything for fear of what will happen to their loved ones when they are gone.

Why is it that a society that provides 10 choices of pizza within every few blocks would have so few choices in healthcare?  Why wouldn’t someone open up a good hospital and a good nursing home and take all of the business away from the lousy hospitals and nursing homes?

I think that the trouble with hospitals is that the person receiving the care isn’t the one paying for the care.  The hospital sees the insurance company as the customer, not the patient.  Because the insurance company doesn’t complain about $10 aspirin or inattentive nurses, there is no incentive to change.  Likewise with the nursing facilities, because no one saves up money to pay for nursing home care, there is no incentive to provide better care.  There is no threat that you will go elsewhere because you have no choice.  It is whatever Medicare will pay for.  And Medicare doesn’t care that the elderly are treated like children.

The Affordable Care Act goes precisely in the wrong direction.  Rather than having people save up and pay for their own care, such that they control the spending, the Act forces people to contribute to health insurance, and then places restrictions on those insurance companies that they will eventually fail, leading to a Government system.  At that point only the wealthy will be able to dictate the terms of their care since only they will make enough to pay for both the government plan and private care.

It is time for the patient to take back control over the direct payment of their medical bills.  Only then will standards improve and prices recede.  The patient must become the consumer to make free enterprise work for medical care.

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