Do free markets in medicine exist? Barely. The Surgery Center of Oklahoma is an example. There are others. Many physicians in private practice do not accept government money. There are more and more that don’t accept payment from third parties, at all. Most of the medical care delivered in this country is not free market, though. Most of it is paid for by third parties and by the government. The extent to which the market is absent is the extent to which the price tends to rise and the quality tends to fall. The extent to which the market is absent is the extent to which fraudulent billing practices rear their ugly head. But make no mistake. The market-based practice of medicine even though battered and bruised and under constant attack wields a power that no government thug or agency can match. In fact, I would maintain that it is the small but powerful force of free market, private practice medicine that holds the entire mess of health care in this country together (otherwise why would Canadian politicians come to the U.S. for their care?!). If every hospital were like the government VA hospitals or the Indian Health Service, there would be riots by angry patients. Where is the drive for excellence and price fairness most acute? In the private market where competition is intense. If a private practice doctor is no good and charges too much, he is out of business…unemployed. If a government doctor is no good he probably gets transferred to torture patients somewhere else that likewise can’t do anything about it and have no alternatives.
An article in our local newspaper today mentions the need for more money for Indian health facilities and Indian doctors. Seriously? Why not close these abysmal facilities and make great care available to these folks? Why not close the VA hospitals altogether and use local hospitals for the military and veteran care? Why shouldn’t the vets and Indians have access to great care, not the trashy government provided type they have put up with for years? Wow! Better care for less money with the savings of closing these government facilities? Makes too much sense, doesn’t it?
The Surgery Center of Oklahoma has had arrangements and contracts with Oklahoma tribes over the years. This has worked beautifully for the tribes with regard to the quality of services provided and the price charged. I have often wondered why the tribes didn’t outsource all of their medical care rather than maintain their own facilities that are high priced and extremely inefficient. The money that we have saved the tribes over the years is a great example of Bastiat’s “what is not seen.” The complications that have not occurred due to the high standards at physician offices and facilities exposed to the discipline of the free market is another example of Bastiat’s “what is not seen.” Less government medicine and more free market alternatives are what the Indian tribes should be working for as this will provide the quality and price combination that is otherwise unattainable.
G. Keith Smith, M.D.
