Informed debate over free-market ideas for health reform.

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Academicians and planners often miss the simple fact that health care by any measure is not a free market. Arguably, there is room for debate. There are no winners or losers in this debate except the American people. They are losing. The Global Burden of Disease shows the US some 26^th out of 33 industrialized countries, close to the bottom in nearly every category.

The concept of competition has merit, but a blank check from insurance companies promotes only competition for the dollar return and not for patient care. The intentions are great, but the planners do not see the forest for the trees. Nearly everything they have done has made matters worse. There is no competition between insurance companies, either now or back before the ACA. There is no competition between providers or between institutions either. With insurance company blank checks each provider and each institution is free to charge whatever they like promoting the most profitable services as would any corporate business. There is no incentive for insurance companies to restrict charges because increased charges result in approved increases in policy pricing and thus revenue. All of these players in health care: insurance, institutions, providers and drug companies are, in effect, monopolies. I submit that efforts to enlist the magic of free enterprise merely codify the monopoly and greed from all players including patients.

Competition with cooperation between states is good. There are vast regional differences in health risk and disease. Competition with cooperation between universities is good; it leads to academic excellence and progress. Open competition with cooperation between providers is good because medicine is a science and diversity of effort, inductive reasoning and sharing of data are the scientific method.

Competition for the dollar in a vital public infrastructure is not helpful. Public health is practically dead on the vine in the US due to the favoring of personal liberties over the intrinsic mandate for the public good – health.

The best competition of all would be between the private sector and traditional insurance company medicine. Competing public systems, run state by state, would increase the diversity, the science and the advancement of medicine -- with patient outcome the reward. Medical schools and city or county hospitals once fulfilled some of that role but not now given the Siren call of pre paid insurance and deregulation. These two competing systems are vastly different. Let free enterprise work for the two systems and let the market determine which system dominates. Let both sides give it their best.

This dichotomy is the real debate in Washington. Let the debate play out in the real world as a competition between belief systems with cooperation between both.

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