Dr. Hsieh’s article offers mere assertions that removing all government mandates will make things better, while admitting that some people will end up without coverage. Such hand waving may be popular among those who value freedom (and most of us do), but is totally unconvincing.
The current system is indeed a mess. A system with no government at all would probably find it impossible to socialize risk in a way that is socially acceptable.
Health care is an unusual commodity – because some of the most expensive health care is simply not optional – it is life or death. Thus the examples in the article (Lasik and cosmetic surgery) are irrelevant – those are almost always purely optional – luxury goods rather than necessities.
I fear an acceptable solution will require some government mandates to insure universal coverage. But it should be for true insurance – that which protects one against unexpected catastrophic costs – rather than routine care.
Of course, if we ignore the idea of universal coverage, but do all the other reforms, we leave many people (especially those of us already trapped in the current system) completely uninsured. A market where many people cannot purchase insurance to protect their savings is a market that discourages savings!
Also unmentioned in this debate is the pathetic state of automation in the medical industry. Hospitals and doctors are decades behind other industries in automation, even though they are buried in paperwork. Many patients die due to mistakes that could be avoided with automation of care. Care is delayed, and costs raised, by the lack of modern ways of transmitting medical records. Dealing with any insurance system that has anti-fraud provisions (i.e. even that which the free market would produce) requires lots of information exchange, and automation could greatly reduce this.
And yet, our much vaunted medical system uses scribbled prescriptions, hand written hospital orders and records, and employs many clerks to deal with payment and authorization issues.
