Monday, September 24, 2007

Purchasing Health Care in a Market System

In today's Wall Street Journal there is a letter from a gentleman who was responding to a column by Karl Rove concerning market based health care. The writer's complaint was that purchasing health care isn't the same as purchasing something like a car. Patients, he states, are 'incapable' of making reasoned decisions when purchasing health care, they just want to be cured.

To some extent he is right, however he overlooks several things. First of all, how is it that people know what car to purchase? It might strictly be price, but quality enters the picture as well. How do we evaluate quality? My guess is that most people who purchase a car do so by relying on brand reputation, recommendation from other people or by reading the countless magazines (or web sites) which evaluate cars. The point is, most people don't know how to evaluate a car, they rely on those people who do know how to evaluate a car. The same would be true for health care if the system operated in a more transparent fashion.

There will always be people who will do the research necessary to determine the best places to buy a particular item, and the same will be true for medicine. Health care providers will try to attract these people. In addition, private organizations will form to do evaluations for their membership. Think something like Consumer Reports. Unions could provide this service to their members. The beauty of this is that people don't have to belong to a Union, or subscribe to Consumer Reports to benefit from their services. As care providers work to attract the knowledgeable patient (or those who have been advised), a shakeout of sorts will occur. There will likely be health care 'brands' that form. People will only need to look for the brand, compare prices with other branded providers and decide which they prefer. We already see this sort of thing with laser eye surgery, for example.

Medical providers like to think that they are somehow above the commercialism of other goods and services. What they don't realize (or maybe they do) is that the commercialism (i.e. marketing, branding, etc.) serves a very important function. This sort of commercialism promotes knowledge in a way that no longer requires people to be experts in order to buy a particular product. If lack of expertise is a problem in a market based health care economy, you can bet that entrepreneurs will find ways to fill the gap, earning income for themselves, but also providing a useful service at the same time. Adam Smith's invisible hand at work.