You give yourself away every time. Yes, you, the healthy person in the room, the one who has never had to deal with extensive and protracted illness. Each time you utter the term “free market” in relation to healthcare, those of us with even a basic level of economics education want to punch you in the face. No offense, but you need it. The free market is the total of all the voluntary exchanges that occur within an economic environment; they are characterized by spontaneous orders of transactions in which individuals make decisions. Going to the doctor is rarely voluntary; filling a prescription, checking into the emergency room or hospital usually are not planned out in advance.

I also do not have the ability to go wherever I want to. Depending on the circumstances, I may have one choice or two. If an ambulance gets me, I go where it takes me, period. That hospital has a monopoly on me for the entire visit, and there is nothing voluntary about it. My insurance has a list of acceptable doctors, pharmacies, and labs it will allow me to utilize. Even if I know in advance exactly what tests will be ordered and what medication will be given, with enough time to call around and get the best price, I am still restricted. And how many times will I have that information with enough lead time?

Those of us with rare diseases (1 in 10 people) require specialists who have knowledge of our special circumstances. We are further confined to the doctors who can treat us correctly; more still to the hospitals where they have privileges. I have personally gone through a dozen internists, six gastroenterologists, two endocrinologists, and three cardiologists, not to mention a plethora of other ologists for smaller problems that have cropped up. I am fortunate to live close enough to a big city where this is possible. My gastro doc goes to one hospital, and since that is usually the reason I end up admitted, that is where I go. Fortunately my insurance company covers that one, so everyone is happy.

One of the more common refrains I hear regarding the high cost of prescriptions is “boycott the company.” That is a great tool in the free market, correct? Well, I take over two dozen different prescription medications; I am lucky my condition has some form of treatment. I certainly do not have the ability to go boycott the manufacturer of a drug, because I think the cost is too high. I am lucky that one company produces it. There are way more people in this situation than any Republican or Libertarian would ever want to admit. In order to do what they want me to, I would have to sacrifice my life. Again, I am not alone in this, nor am I a one-off patient.

Once what seems obvious to the rest of us is accepted by everyone else, we might actually make some progress on healthcare. Otherwise, I invite Paul Ryan to walk a mile in my house shoes, and show me how I am doing it wrong.

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