I'm no fan of Medicare Advantage (or indeed of Medicare in general), but it is not a "free market" program. It has the same problem all socialized health care programs have: the people who are actually getting the care, patients, have no idea what it costs, so they can't judge whether the care they are getting is worth the cost. A free market program would be one in which the patients paid the costs directly and could shop around for the best deal, just like in the rest of the free market. If you want to help people who might not have the money to pay those costs directly, the obvious thing to do would be to subsidize them, the way we subsidize food purchases now for the poor with food stamps. Food stamps just give people a monthly sum they can spend on food; they don't go and negotiate prices with all the grocery stores and then argue after the fact about whether a particular food purchase was covered.
It is true that in some situations, like emergencies or accidents, patients can't shop around. That kind of situation is indeed what insurance is for. But programs like Medicare, and indeed socialized health care in general, go way beyond insurance. Insurance is for high cost unforeseen events. Most health care is not high cost unforeseen events; it's foreseen events like physicals, shots, checkups and prescriptions for chronic conditions, etc., or low cost unforeseen events like getting an infection and needing treatment. If all of those things were provided in a free market, health care providers would be much more efficient, and it would be much easier to negotiate reasonable terms for insurance for the truly high cost unforeseen events that insurance is for. Medicare Advantage (and Medicare and socialized health care in general) is of course nothing at all like that.
> It has the same problem all socialized health care programs have: the people who are actually getting the care, patients, have no idea what it costs, so they can't judge whether the care they are getting is worth the cost.
Let’s imagine (unrealistically) that through some technical breakthrough, patients knew the cost before making their purchasing decision. They still do not know what it is worth, because they have no idea what the risks of not being treated are. There is a problem that your doctor also probably does not know the cost, but they are the only person in the decision making process with the information necessary to make a rational recommendation. (And, unfortunately, they usually have a conflict of interest.)
Healthcare is different from buying cars or groceries - even if you know the relative costs, you are unlikely to know the relative benefits.
> They still do not know what it is worth, because they have no idea what the risks of not being treated are.
I disagree; I think that in most cases patients do have a reasonable idea of the risks of not being treated. Where I think risk information is often not communicated very well to patients is in the risks of being treated--what the actual success rate of the treatment being proposed is. That is because in our non-free-market system, doctors have a strong incentive not to let patients know what their actual success rates are, and there is nothing that can counterbalance that. In a free market, they might still not want to, but they would have no choice, because that information is valuable enough to patients that if doctors don't provide it, someone else will. (Other parties try to do that even in our current system, but they are limited in what they can do by legal restrictions imposed by the government.)
> [Doctors] are the only person in the decision making process with the information necessary to make a rational recommendation
I disagree with this as well. My experience with doctors has been that I usually know more than they do about my particular condition. (My wife, who has several chronic conditions, has had this experience even more strongly than I have.) I may have less overall knowledge of all medical conditions in general, but that's because I don't treat any patients other than myself, while they have to treat lots of them. But I have a strong incentive to learn about my particular condition that my doctor does not have, and that usually beats the doctor's general knowledge.
All I can say is that you go to very different doctors than I do. I have quite a bit of confidence that my doctors know a lot more about the risks of different treatments than I do. If I had your doctors, I would try to find doctors I had more confidence in.
> But I have a strong incentive to learn about my particular condition that my doctor does not have, and that usually beats the doctor's general knowledge.
except your experience is not really generalizable across the entire population. Some people are in no position to do this due to the severity of their issues and many other would never feel as confident as you about knowing more than their doctors.
> In a free market, they might still not want to, but they would have no choice, because that information is valuable enough to patients that if doctors don't provide it, someone else will.
Right you’re implying that most people are capable of judging the quality and accuracy of this information which they are clearly not. That someone else might be a scammer selling some magic healing crystals or whatever. You do realize the inherent flaw in this whole concept? Often there is no way for clients to evaluate the effectiveness of the treatments they receive until it’s too late (this is why healthcare can’t function without extensive regulation).
> insurance. Insurance is for high cost unforeseen events. Most health care is not high cost unforeseen events; it's foreseen events like physicals, shots, checkups and prescriptions for chronic conditions, etc., or low cost unforeseen events like getting an infection and needing treatment
Is that really true total cost wise?
> Food stamps just give people a monthly sum they can spend on food;
So you’re saying that this approach (giving people a fixed sum) certainly wouldn’t work for healthcare due to perfectly obvious reasons you’ve described?
> Food stamps just give people a monthly sum they can spend on food; they don't go and negotiate prices with all the grocery stores and then argue after the fact about whether a particular food purchase was covered.
Not taking away from your general argument, but only some food assistance programs are like that: an allowance you can use on any approved item; others are more like a coupon for a certain size container of (a specific type of) milk, butter, eggs, etc.
> only some food assistance programs are like that
As far as I know, food stamps, which work the way I described, are what the vast majority of people in the US who get a food subsidy at all have. I'm not familiar with the other programs you describe; can you give some examples?
It’s very difficult to shop around when there are few options to shop around at. Also impeding the free market is a low supply of medical expertise. There has been a lot of consolidation in provider networks and systems. Many doctors and nurses have been leaving the profession due to stress, overwork, liability insurance, etc.
All of the issues you describe, which are all valid issues, are consequences of the lack of a free market. Medical expertise is not provided in a free market; doctors have to be licensed by the government. Consolidation of companies is due to the fact that there are economies of scale to be had when your company has to specialize in government contracting and lobbying (the consolidation of defense contractors over decades has happened for similar reasons). Doctors and nurses are stressed and overworked because their supply is limited (due to licensing, as above) and because limited time and tons of bureaucracy due to all the third party players involved (players that wouldn't even have a say in the process at all in a free market) gets in the way of caring for patients.
For perfectly good and valid reasons. Consumers are inherently incapable of evaluating the quality of healthcare they receive in many cases. This is perfectly obvious.
It is true that in some situations, like emergencies or accidents, patients can't shop around. That kind of situation is indeed what insurance is for. But programs like Medicare, and indeed socialized health care in general, go way beyond insurance. Insurance is for high cost unforeseen events. Most health care is not high cost unforeseen events; it's foreseen events like physicals, shots, checkups and prescriptions for chronic conditions, etc., or low cost unforeseen events like getting an infection and needing treatment. If all of those things were provided in a free market, health care providers would be much more efficient, and it would be much easier to negotiate reasonable terms for insurance for the truly high cost unforeseen events that insurance is for. Medicare Advantage (and Medicare and socialized health care in general) is of course nothing at all like that.