Health Care -- an analogy

So there's a massive debate in Washington about how to remake American health care. Our health care "system" -- well, it isn't a system at all, because that would imply some sort of design -- but our health care approach is nothing short of madness. It is a system without price tags, competition or any of the other hallmarks of a free market. And yet this bastardized model is being defended by the right in this country as the "best health care system in the world." Which it demonstrably isn't.

The chief shortcomings of our approach are these: 1) It does not produce acceptable health outcomes; 2) It is obscenely expensive; 3) It is grossly unfair; and 4) It is mind-bogglingly complex. There is a simple reason for this: Health care institutions in the United States, from hospitals to pharmaceutical companies to medical-device suppliers are all constructed around the premise of profitability, not health outcomes. Thus, our health care system fails at producing healthy people, but succeeds wildly in producing profits. This is not mysterious.

Look, I took economics in college, and I get the concept of free markets. I embrace the concept of free markets. I love free markets. They can work wonders. But the idea that we have a "free market" health care system is a fallacy, a lie, a deception. We have a semi-free market in health insurance, which is not at all the same thing.

To illustrate my meaning, I want to give you an analogy. We all need food to live, so imagine that you are going to the supermarket. In reality, supermarkets are vigorously competitive, free-market businesses, which compete ferociously over pennies and nickels. There are numerous competitors, many sellers and buyers, and very transparent information about pricing. Every item has a price tag. You can compare items side-by-side. Good products and brands engender loyalty. People make rational choices on the basis of taste, quality, price, and preference. It works.

Now imagine the supermarket worked like our health care system... How would it be different? You arrive and are issued a cart. Before you are allowed to shop, a stern official-looking person checks your credit. You then must wait your turn to enter the store to fill your cart. About an hour later, you are issued a wrist band and permitted to enter, attended by a highly-educated foodsycian employed by the supermarket. He talks with you sympathetically, and steers you down certain aisles, recommending certaing foods.

Nothing has a price tag on it; it would be difficult to mark each item anyhow, because the price could vary by a factor of 10 depending on which shelf you took it from. A can of mushrooms from the end cap could run you $7, while one from the back of the regular shelf of canned mushrooms might be $.70. Or vice-versa. But you won't know until later... Anyhow, you proceed up one aisle and down the next, with your foodsycian urging certain foods and forbidding others. What he says seems to make sense, but you're not really certain, and he's really not answering your questions about pasta. He won't even let you look at the Mexican foods. You bite your tongue, in part to quell your rising hunger.

At the end of one aisle, he stops you. "Wait here for your frozen-food specialist." You wait here for three months, starting to feel a bit faint. Finally, your specialist arrives, and leads you through the freezer section, adding numerous unlabled products of significant weight to your cart. You don't know what they are, but are told they're very important. You sigh.

Finally, it is time to check out. This part is a breeze: You just put everything in bags and put it in your car and go home. They have been keeping track of your selections the whole time. They're very conscientious about keeping track of what went into the cart. A few weeks later, a bill arrives. This is the first time you get to see the price of any of the items in your cart, most of which you have already consumed. The charge is $10,503. Separate bills arrive a week later for the services of the foodsycian and frozen-food specialist, adding another $2,372 to the tab.

That's pretty hard to take, but things are looking up. You've been offered a job with a new company. You go in to meet the H.R. guy, and he makes his offer: A good salary, and they offer food insurance. They will cover about 3/4 of your food bill, but there are quite a few rules you'll have to follow, and lots of forms to fill out. Anything, you tell him, would be better than the shock of opening another bill for 10 grand! He smiles -- he knows that you'll soon be like the rest of his employees: Kept in the fold through a carrot-and-stick system -- happy to have the job, and terrified of losing that food insurance.

This is our health care system, America. Would you vote for it?