I disagree that letting the market force fix things will work. It might provide a small improvement, but not to the level I think really is needed.
Lowering overhead costs can be done without removing insurance companies, simply by streamlining the process, which is badly needed.
Market forces would unquestionably lower costs. The simple economic reality that most people cannot pay for their own
routine healthcare out of their own pocket is sufficient to ensure that market forces would quickly and dramatically slash healthcare costs across the board. That market forces would lower costs is not a major question in healthcare debate.
What is a major question is that of "who pays?" Dear Leader wants the government to pay through tax dollars--that $684Billion will not come out of thin air, and will be the result either of tax dollars or Helicopter Ben Bernanke and his magical printing presses. Hillary Clinton wanted to force everyone to buy health insurance. John McCain had a much underappreciated notion of providing a tax incentive for people to buy their own health insurance, resulting in the ending of health insurance as an employee benefit.
The problem with government-paid healthcare as well as health insurance as it currently is offered it that it is a perversity of everyone paying for someone else's healthcare. It isolates the patient from the full pricing information necessary to make effective economic decisions about healthcare. In effect, patients are denied the full opportunity to choose for themselves how they wish to provide for their own health and well being--and the consequences of this reach much farther than mere dollars and cents.
Consider, for a moment,
this interesting comment on prostate cancer treatments:
Because of these side effects, some men, especially some older men, may decide that the cure is worse than the disease. Studies show that some men are willing to accept the risk of a shorter life span in return for a better quality of life than what they would have with treatment.
The significance of this comment is that it begs the question of how do we determine what treatments are "necessary" for a given condition. Is a better quality of life obtained from longer life despite numerous expensive medical procedures? Or could a better quality of life be obtained by spending the money otherwise paid out for such treatments on other, more pleasant things, even though a shorter lifespan might be among the ultimate outcomes? Is prevention and a focus on healthy living preferable to treatment and remediation after the fact? Who is best situated to make such determinations if not the patient. What is the best use of that patient's resources for that patient's overall life?
The challenge of that position as a matter of healthcare policy is that it compels us to confront mortality directly. In government and in our individual lives we are compelled to ponder at what point should nature be allowed to take its course with the catastrophically injured or disastrously ill? If there is no insurance, no safety net, what happens when someone is the victim of a car accident through no fault of their own? Are we willing to consider the possibility that some conditions and some diseases are, in fact, "too expensive" to cure?
Thus, the drawback of imposing market forces is not that it will not have any impact, or will have only modest impact, but, to the contrary, that it will have traumatic impact--that at least in the immediate aftermath of such a transition many life-or-death decisions will be made solely on the depth of the pocketbook, which outcome is decidedly at odds with normal perceptions of social justice and fairness, while the disruptions and dislocations of such a transition would put some patients at risk of not having vital treatment and testing services available when they are needed.
If the imposition of market forces were merely a question of efficiency and cost control, there would be no argument of substance to the contrary. In a free market environment, every person would be assured of having access to all the medical care they were willing and able to pay for. As a matter of cost containment and systemic efficiency, the free market wins every time.
However, the challenge of the free market is not merely about cost, but also about what should be the governing philosophy of health care. Should there be guaranteed treatments and few resultant treatment choices? Should there be no guarantees and maximum treatment choices? What is more meaningful, the choices of the individual or the preferences of the collective?