Medicare for All: How Expensive?

In the perennial debate about the cost of health care in the United States, those opposed to Obamacare and/or Medicare for All typically argue for a continuation of what they call “our free market in health care.”

Spirited Reasoners know there is no such thing, never has been, and never will be. Here’s why not:

  1. Patients don’t choose their illnesses and injuries the way shoppers choose merchandise or services. Many expensive decisions—as in those where a heart attack or car wreck victim is taken to the hospital by strangers—are made when the patient is unconscious or in no position to choose one provider over another. Do those arguing for a free market in health care really expect the patient to debate with the EMT when their time comes? “No. I don’t want this ambulance company to take me to the emergency room. It’s too expensive. And please take me to that hospital rather than this one.”
  2. Many small towns and cities in the United States have no meaningful free market in hospitals, specialists, and other health service providers. In those places, the choice is not like deciding to eat at McDonalds vs. Burger King, where quality control is standardized nationwide, and we all know pretty much what to expect. If I live in one of these places and happen to need a specialist, I might be stuck with the only one in that field who happened to open an office in my county. And that person might not have the background and credentials for which I was hoping.
  3. Patients don’t control the list of doctors their insurance companies consider to be “in network” or “preferred providers.” Even the savviest patient, having chosen a particular insurance company precisely because it includes a favorable list of providers, might be shocked to learn that the insurer is free to change that list from year to year for reasons having nothing to do with customer service.
  4. Unlike their experience in restaurants, patients are never given a menu of available services with prices attached. On the contrary, what they experience is the shock of receiving bills from multiple providers whose names they never knew and whose services they didn’t expect. “Here’s the bill from your surgeon. And here’s the one from your hospital. You’ll see the itemized listing for everything we did to your body while you were here, whether you knew it or not. We know you didn’t agree to all the prices for each of these services in advance, but hey, there’s no law against it. And don’t forget that the anesthesiologist has a separate corporation for billing. We know you didn’t choose this anesthesiologist by name, but he was the only one your surgeon would accept.”

Free market in health care? It would be like citizens demanding a free market in the water that comes out of their kitchen taps. Or demanding that everyone be allowed to choose their own private police or fire department coverage rather than the ones provided by local government. Some things need to be provided by a single source whose services are overseen by We the People, not private insurance companies.