Free market solutions work just fine. I fled the semi-socialized US system to enjoy the unfettered free market medical system provided by India at least twice, and will probably do so for future medical treatments.
Many medical services are repeated even if good service is provided. For example, 2 years ago I injured both my L5/S1 and L4/L5 disks. 2 years ago L5/S1 was treated, but the L4/L5 was left alone since it did not cause any problems. This year my L4/L5 started causing serious pain - the first guy did a great job so I went back. Another part of the feedback loop is reputation - if one of my friends needs similar treatment they'll probably go to the same guy unless they are very sensitive to cost (I didn't go for cheap).
I have no idea where this meme that free market health care looks like the US comes from. Maybe Canadians don't realize there are more possibilities than simply Canadian and US health care?
It seems more than coincidental that many of these problems began around the same time insurance companies began large health maintenance organizations (HMO's). It's clear that the original intent was to keep costs lower for the participants by spreading the fee-for-service billing model among a larger pool of subscribers. However, this has completely subverted the incentive structure. Doctors bill higher (and differently) for equivalent procedures while insurance companies spread that 'risk' by charging higher premiums. Couple that with Hospital consolidation, and incredibly strong lobby, monopoly pricing power with zero cost visibility and you have.. this.
.. opaque pools of collateral (subscriber) tranches, zero cost visibility, monopoly pricing power.. sounds like they're trading mortgage-backed securities. That didn't end well either.
I'd also like to point out, as it doesn't seem like people go far enough in these sorts of analysis. We tend to draw some arbitrary line of causation, conveniently where it suits us. Obviously, the further back you go, the more difficult it is to draw conclusions and link causation/incentive, but it's important to at least try.
E.g. You claim that the problem stems from HMO's spreading risk/cost using premiums, and doctors using that to over-charge fraudulently. But, have you considered why the doctors are able to do so (and get away with )? Perhaps because there is a shortage of them. Or something else, the point I'm trying to make is that we need to go a little bit further.
> I have no idea where this meme that free market health care looks like the US comes from.
India shouldn't be in a Canadian's comparison set with respect to health care systems. The resource differences are too great to learn anything useful about the impact of other dimensions. Can you name a developed country with a health care system as or more free market than the American one?
As for your experience in India... Consider how much wealthier you are than the average Indian. If you were that much wealthier than the average American, do you really think you'd have any complaints about the American health care system? Conversely, what do you think your experience would have been if your wealth relative to the average American has instead been your wealth relative to the average Indian?
My surgery cost me roughly 1-3 months of a typical Indian software engineer's salary. If my relative wealth had been the same it would have been a very good experience.
In contrast, there was a recent NYT article about a person in the US who underwent a similar surgery. A single billing discrepancy (to say nothing about the entire bill) is comparable to a software engineer's yearly salary.
Furthermore, the experience was easy, with none of the nonsense I deal with in the US. When I got to India, my initial medical exam cost roughly the same as a dinner at a decent restaurant. An MRI cost me the same as an expensive night out. I was given a price quote for the treatment and the total cost (including incidentals) was within 2-3% of the quote. The only person who even tried to rip me off during the process was the auto rickshaw driver who took me home.
Certainly the bill would have hurt me more if I were a typical Indian. But the experience I'm describing is not the wealth gap. I know people who are "that much wealthier" than the average American and they do have lots of complaints about the US system.
So, erm, what about all the poor people in the US that can't take a journey out to Asia when they need care?
(I don't automatically disagree with your free-market assertion, mind you...we have quite a captive one here. You just need to use a bit better justification.)
I didn't claim that medical tourism is the solution to all problems. I merely claimed that there are highly effective free market medical systems. I.e., the world is bigger than simply USA and Canada.
Well, medical-tourism isn't an answer to everyone's problems, at all ends of the socioeconomic spectrum. But if your assertion is indeed correct (that poor people aren't getting access to medicine in the US), then that's another argument against socialized (at least of the American-kind) medicine, and not at all a failing of free-market medicine.
"I have no idea where this meme that free market health care looks like the US comes from."
Probably brought to you by the same spin-doctors that invented the mythical "trickle-down" economics theory.
Many medical services are repeated even if good service is provided. For example, 2 years ago I injured both my L5/S1 and L4/L5 disks. 2 years ago L5/S1 was treated, but the L4/L5 was left alone since it did not cause any problems. This year my L4/L5 started causing serious pain - the first guy did a great job so I went back. Another part of the feedback loop is reputation - if one of my friends needs similar treatment they'll probably go to the same guy unless they are very sensitive to cost (I didn't go for cheap).
I have no idea where this meme that free market health care looks like the US comes from. Maybe Canadians don't realize there are more possibilities than simply Canadian and US health care?