Late Stage Capitalism

Health care is especially terrible as a "market" because it doesn't work like other markets.

For example, if you have a 50% chance at something costing $100 happening, you'll probably make sure to have $100 available. If it's a 20% chance you probably have a plan, just in case. But, what if it's a 0.1% chance of something costing $100,000 you might take a gamble and not even bother with insurance. If you do get insurance, how do you calculate what is a reasonable price for that insurance? An extremely rare chance at an extremely expensive thing isn't the kind of calculation people do when they're shopping. The result, of course, is a lot of medical bankruptcies -- a phrase that simply doesn't exist in most countries.

Then there's the ridiculous idea of trying to shop around for health care. If you're having a heart attack, are you going to check to see which hospital has the best rates? Are you going to look up ambulance services online to see which one has the highest reviews? Even if it's something that isn't urgent, are you really capable of spending your money wisely to figure out which hospital offers the best price to performance ratio for a condition you can't pronounce, let alone understand? Markets only work when the shopper is informed, and it's very hard to be an expert on health care without being a health care professional (and even then, you might only really know your own specialty).

In addition, when you mix in preventative care, health insurance gets complicated. If you're healthier, you don't need as much insurance, which hurts the profits of insurance companies. On the other hand, once you do have insurance, they want to keep your premiums high without using their coverage, so they want you to live healthy... but not so much that you change or cancel your insurance. When health care is provided by the government, it's much simpler. It's best to keep everybody healthy and do as much preventative care as possible.

Finally, there's the issue of externalizing costs. If someone doesn't get insurance, they don't get left to die on the street. They get taken to a hospital and they get treated. Often, they're presented with a bill after that, which then can result in a medical bankruptcy. Who is ultimately on the hook? Taxpayers. It's just that responsible people who are able to afford medical insurance pay for their own care, but then through their taxes they also pay for health care for people who don't / can't get insurance. And, even though it's not financial, there's also the externalized cost of not getting treated.

Say you live in a city like NYC where everybody takes public transit. You really want to make sure that everyone else there showers, avoids too many perfumes, and doesn't take the train when they have a contagious illness! If someone doesn't have health insurance, so they can't go to the doctor when they get a cold, the flu or some kind of flesh-eating bacteria, they're much more likely to be on the train with that untreated illness with everyone else. In addition, things like a pandemic are much more likely to spread if someone can't afford to go to a doctor when they get sick. You're more likely to need health care in a country without universal health care simply because you're around people who don't have health care and might pass whatever they have to you.

Most economists agree that maybe a market is a great way to generate efficiency for things like pencils and tee shirts, but it's just not suitable for healthcare.