There is no ‘free market solution’ to health care access

Updated

Not every problem has a “free market solution.” In the case of health care, promoting the market society and promoting well-being are fundamentally contradictory ends.

“Now you sound like a lefty,” host Chris Hayes told Elise Jordan, the lone conservative panelist on Sunday’s Up with Chris Hayes. Jordan, a former communications director for the Bush-era National Security Council, had just taken a stab substantively critiquing the Affordable Care Act from the right. The problem, she said, was that the bill had not addressed some of the deeper flaws in the health care system.

The architects of the bill, she said, “tried to satisfy too many parties. And so they made insurers happy, they made pharmaceutical companies happy, and they didn’t achieve real reform.” She went on: “Why do Americans not know what a service is going to cost when they go to the hospital or the doctor’s office?”

A bleeding heart, pro-single-payer progressive couldn’t fault that argument. But Jordan parted ways with the left when she stated her preferred remedy: “I want a free market solution.”

Tellingly, that’s where she stopped. It was an odd way to close, for reasons that co-panelist and radio host Sam Seder abruptly seized on. “There is no free market solution to the problem that you’re talking about,” he said. “That is a function of the free market.”

Whether or not there is, in fact, a free market solution to fixing American health care probably depends on what constitutes a “solution.” Is creating and sustaining markets in all sectors of society an end in of itself? Or is universal health care coverage the goal? Seder touched on an important point, which is that these objectives are in tension with one another.

Later in the show, Chris Hayes illustrated one reason why. “The key market mechanism is that I walk into Bed Bath & Beyond, and I decide, I want those shower curtains or those shower curtains, and then I price it out and I can decide my preference,” he said. “I don’t have a shower curtain doctor who comes in and says, ‘Based on my expertise in shower curtains, you have to get this shower curtain.’”

Additionally, no one sees universal shower curtain ownership as a valuable policy goal. The consequences of not being able to afford a shower curtain are that you don’t buy a shower curtain. The cost to society is that Bed Bath & Beyond doesn’t make the $20 they would have otherwise made off of your purchase.

The calculus for health care is considerably different. If you can’t afford that, then the consequence isn’t just a wet bathroom floor; you might actually die, which carries its own considerable societal costs. You can conceive conceive of those costs in economic terms (a potential producer and consumer of value going to waste), but we don’t need to think about dollar value in order to see why people dying is a bad thing. All but the most hardcore, Ayn Rand-worshipping market fundamentalists tend to see preventing needless death as a worthwhile policy goal in and of itself.

But you can’t orient a functioning free market around that policy. Let’s go back to the shower curtain example. Say that we lived in a society where it was considered morally unacceptable to let anyone, even the most unfortunate members of our society, live life without a shower curtain. So if you go to Bed Bath & Beyond and tell them that you don’t own a shower curtain and can’t afford one, they have to give you their cheapest model for free. You can pay more for a nicer curtain if you’d like, but there’s no chance of you walking out of the store without any curtain. There’s still a market for curtains, since people still have variable curtain preferences, but the market is much more limited.

A truly free market alternative is simple: if you don’t have the money for a shower curtain, you don’t get a shower curtain. If you don’t have the money for medical treatment, you don’t get any of that, either. Depending on your priorities, you might be fine with that. But if you consider fostering markets everywhere a lower priority than keeping people alive, then the distribution of medical care is probably something you want to insulate—at least in part—from the vicissitudes of a market economy.

There is no 'free market solution' to health care access

Updated