Perhaps a bigger reason why people do not go to the doctor annually is the fear of what they will find out and perhaps a lack of faith in medicine. No “insulation” system will solve that.

BTW: I do not like Kling’s “insulation” term. It is really insurance versus pre-payment plus insurance. As should be obvious, no pre-payment system can be cost-efficient since one is paying a third-party to manage the payments (either the government or insurer in the case of healthcare). Pre-payments only make sense if one does not want to be bothered with managing the billing process oneself for some reason. Those cases would mostly apply to the rich and those who value time over money.

This is the most curious thing about health care. Elites have people convinced that they can not make informed decisions about medicine and the alternative that they offer is to allow essentially a disinterested third party to make them instead. So we are faced with pretty much the worst of both worlds. The situation can be improved by either getting the third party out of the way and giving Doctors total control over treatment or making the patient responsible for the choice. Since the former is unsustainable because the medical community will do what anyone would do in that situation and tend toward greater usage and more costly care, the former is really the only way forward.

The patient may be an imperfect arbiter in this scenario but he is at least the one that has the most obvious motivation regarding the outcome.

The proper attack I don’t think is against information, because I don’t think there is any doubt that doctors have the edge when it comes to the capacity for evaluating symptoms and recommending proper testing, treatment and prevention. You can say that individuals have a greater incentive to become knowledgeable about their own health, but at the end of the day the education gap is generally so large that at least I don’t personally find it persuasive that individual consumers will make better decisions regarding their health care than would a physician even given roughly equivalent information.

I think the best attack is sustainability–in the short term insulation seems like an “everyone wins” situation, when in reality it is not. In the long run the insulation model necessarily becomes governent-run health care, and few people can make the argument that government-run health care is better for everyone. Markets are better because they are sustainable, and over time advances in technology and production improves service for everyone, and the alternative is a sure slippery slope to government health care.

For all of that it still begs the question like so many things that if the marketplace of information is such a great thing why we continue to move leftward when it comes to health care policy.

The fact that the insulation model makes your initial medical contact free does only one thing and that is remove one disincentive, among many, to seek health care. After that the systems would be able to create the exact same information with the exception that the insurance system, since it is unfettered by the same degree of oversight, would in my opinion create better and more reliable information more quickly, thereby producing the best result in a medical crisis since time is of the essence. Additionally it creates a less expensive result since there is less administration.

Explain to me why the insulation model produces better information.

I am not saying that medical markets are not the most efficient solution, but waving our hands and chanting “elitist fabrication” the way a second-rate magician says “hocus pocus” any time someone challenges our notion that fully free markets are the cure-all for everything is one of the reasons we’re not taken quite seriously by a lot of people. If we’re that dismissive of any challenge to market efficiency, why aren’t we all militant Randians, off to start a boutique country with no government whatsoever? I believe I am a good libertarian, in particular with respect to wanting to find ways to communicate our ideas persuasively rather than with an elitist snort and hand-wave of our own.

That’s one of the reasons I enjoy Cato Unbound, and thereby one of the reasons most of my posts here are in response to their essays. However, so far this month (and unlike many prior months) I haven’t seen the kind of opposing vewipoint I would expect to create a true debate,

I am a husband and father of 2 and due to some good luck am currently not employed by choice, so I do not have access to an employee health plan (love that euphemism) but I do have insurance. My family is covered by a catastrophic health policy (that is such a dramatic term) so pretty much all our medical care is paid for out of pocket as none of us has come up with any nasty diseases or accidental injuries (except my knee surgery 2 years ago which was to some extent elective and was to some extent paid for out of pocket). To me, the only logical way to use a catastrophic health policy is to go to the doctor from time to time to see if you need to put it to work. Otherwise you are purchasing something that you intend to use at its absolute lowest utility.

Certainly there are people that function in that way. Anyone driving a Cadillac Escalade or its like is purchasing something wildly maladaptive to any actual transportation function imaginable. But most people, just as they drive much more functional automobiles, would realize that the proper use of medical insurance would also entail keeping track of your health well enough to know when the insurance is needed. In addition, it wouldn’t take Doctors and Hospitals long to change their marketing and pricing in ways that would drive traffic through their doors, hoping that at least a bit of the traffic required expensive procedures that could be billed to insurance companies. My guess is that without insulation there would be a huge reduction in the cost (and paperwork, but that’s another issue entirely) of a basic physical and a huge increase in marketing them. I think the average person would respond in their best interest and shell out a few bucks to safeguard their most significant asset, their life.

To make real health insurance work doesn’t require that people become experts in medicine, it only requires that they realize that they need to purchase medical services. Certainly lots of people seem to be able to purchase legal and accounting services. People have also found that buying information in the form of internet access and cable services is worth quite a bit to them. Last year my family, thank God, had another uneventful year medically, but we still all got physicals. And we spend quite a bit less for the medical services that we consumed than we did for cable and internet access. The idea that people can’t manage their own health is just another elitist fabrication and you, good libertarian that you are, should be able to see it for what it is.

Beyond that I do (not being Devil’s advocate) quite serious contest your comparison on a complexity level of shopping for a car, shopping for a computer, shopping for an appliance vs. taking much more direct control over your health care. That isn’t in and of itself to mean that free market’s aren’t the most efficient, just that I go back to my last paragraph–why are libertarians (myself included) so afraid to acknowledge the major, major complications related to certain types of markets? If we’re serious about saying that markets are efficient when consumers make informed decisions then we have to face straight-up situations where that is difficult or impossible rather than just deny such complexity and challenge exists.

If you said yah, this is a really, really difficult market for consumers–much more than the average market–but in spite of that the market is still the most efficient solution because (a) it meets the challenges by doing X, (b) the alternatives aren’t sustainable solutions, (c) the market is complex but you’re short-selling the consumer, who will likely spend a proportionately greater amount of time seeking accurate information about his/or own health than they would making decisions with simpler markets, (d) etc . . . then at least I’d have something other than denial to chew on.

My primary beef with Holt is that his denial lies directly with sustainability. He’s essentially saying hey, it hasn’t broke yet so why worry? Maybe it will never break! That kind of head-in-the-sand analysis doesn’t fly far with me, but it also doesn’t excuse libertarians from facing the legitimate issues Holt raises.

btw thanx for the comment.

I don’t understand why Mr. Holt seems to think that this time its going to be different (an attitude that he attacks Kling for).