You go to Pickle Barrel and order a sandwich. Without even asking, the employees give you double meat, double cheese, a cookie and a bag of chips. When you ask how much they cost, the employees shrug and say, “who knows? It depends on your Food Insurance Provider.” Two weeks later, you get the bill. It’s $15,000 because, as it turns out, Pickle Barrel is not in your Food Insurance Provider Network. Add a bleeding injury and the overwhelming fear of death, and this is what people mean when they say they want a “free market in healthcare.”
The healthcare “market” bears almost no resemblance to any other market in the U.S. The fundamental features of the idealized free market include things like known prices, competition between many firms and consumer choice. When a person calls 911, especially in a small town, they are taken to the only hospital in the area and have medical interventions applied with little or no input from the patient. They consent to “receive treatment” in a general sense. Then, doctors and nurses conduct various medical interventions, each with a price that is never disclosed to the patient.
My roommate was recently in physical therapy after a shoulder injury. He asked a nurse about the pain-relief patch she was about to apply to his shoulder; it cost $400 and was classified by his insurance as a “luxury,” so it wasn’t covered. Had he not asked beforehand, he would have lost a month’s rent in exchange for some mild pain relief. This is not the kind of experience customers have in a genuinely free market. The U.S. healthcare system contains none of the elements that constitute a free market in any real sense.
The real long-term solution to massive healthcare costs is a single-payer system strong enough to negotiate with medical supply and pharmaceutical companies from a position of power in order to reduce prices. However, a simple and cost-free reform to force the healthcare market to function even marginally as a real market would be the requirement that medical interventions have listed prices and that patients can accept or reject various treatments after seeing the cost. A bill has recently been introduced in the Montana State Legislature to do just that: SB 362, introduced by Ed Buttrey (R-Great Falls), would require clear and listed prices for medical interventions in the state of Montana. This is a huge step forward — not nearly enough to provide healthcare as a human right, but enough to make sure no patient accidentally loses a month’s rent in half a second because a doctor or nurse slapped a patch on their arm.