Free Market Medicine - Is it Rational?

This weekend J, who is an ER doc, said that universal health care would not be a good idea. His reasoning was straight-forward: if you provide the public with something free they will exploit it. By not providing things for free we encourage people to work and plan for what they want and need. This encourages responsibility and industriousness.

I agree with this. Except that J is not talking about a typical consumer good like a car or computer. Health care is different, and for two basic reasons.

1. People don't think of their health like their cars. Any American will agree that if your want a car, work hard and save the money. If your car breaks down, you'll be responsible for fixing it. No money, no repairs. But disease is different. If someone has diabetes they expect to have some level of care regardless of they ability to pay. Many Americans - especially those with chronic diseases - would think it is unfair that a diabetic who needs to see a doctor could not do so because they had no way to pay.
2. Doctors don't think of medicine like a mechanic thinks of repair work. A mechanic can be successful if he follows the basic principles of business: provide good quality at a low price. Profits shape his business and motivate him to work. Although many doctors too are motivated by profit, the large majority are more motivated by their professional code of ethics. This code is about caring for the patient, not making money from him, and as a society we allow people to practice medicine because they follow this code rather than chasing after profits. If my car breaks down perhaps I will chose to go to the mechanic who, though not the best in the city, is good enough and inexpensive to fit my budget and the value I place on my car. If I get sick it is unlikely I will use the same thinking: no, I don't want to see a doctor who cuts corners to save me some money. I want the security that I am getting the best care I can get. Yet on the other hand I don't want to get gouged or spend money on my car repairs than what is really necessary for my needs.
   

When it comes to medicine we have a "spend whatever it takes" attitude about solving problems about our own health of that of those we hold dear. This is untenable from a public health standpoint, but it is nevertheless our attitude about the matter. There is nothing else - save national defense - about which we would think the same.