Healthcare and the Free Market

TO: The Editor, Wall Street Journal

In “How to Stop Hospitals From Killing Us” (Review, Sept. 22), Dr. Marty Makary tells the “what” part of the story, but not the “why.” The reason patients choose a hospital based on parking and provider performance is opaque to patients is that the consumer is not directly paying the provider. Insurance companies and, increasingly, the government are the payers. When they pay for their own care, patients will become more selective shoppers and spenders. When doctors and hospitals are being paid by patients, the cost will be better controlled and quality measures more transparent. One great myth of our time, that health care is too expensive to be afforded by the public, is exploded by the burgeoning market for cosmetic surgery, veterinary care, bariatric (weight loss) procedures, and LASIK eye surgery. Providers of these cash for care services are totally and directly accountable to consumers.

Makary states that “government must play a role in making fair and accurate reports available to the public.”Does a consumer who is paying for and purchasing services need the government to decide what is “fair and accurate?”In cosmetic surgery, for example, results of competing providers and consumer reviews are easily available on many websites (e.g. Realself.com) to help patients choose based on quality and cost. Questions can be directed to multiple providers online, consultations are free, and outcomes transparent. Doctors face disciplinary action or expulsion from professional societies, in my case the American Society of Plastic Surgeons, if reported by a competitor for unethical advertising or practices. In a free market where the policing function is delegated to competitors and reporting is confidential, self-regulation by the profession is very effective, not to mention accountability added by the plaintiff’s bar.

If all the money American workers paid into government healthcare programs such as Medicare were kept in medical savings accounts (MSA) with the owner’s name on it and the owner could choose how to spend it or NOT spend it and pass along to heirs, coupled with high deductible insurance to cover expenses exceeding MSA balances, health care costs would plummet, accountability, transparency, and quality of care would soar, and there would be more than enough left over to pay for the care of our indigent population.

Steve Laverson, MD

Encinitas, CA