I’m in total agreement with the idea that a free market system can work. The less the governmnet is involved, the better.

You said; Why do we need a doctor’s order to have blood testing done?

Just wanted to let you know that there are several states that do no require a Dr’s order for lab tests. In Missouri you can walk into a hospital and have any lab test done without a physicians order. You won’t, however be able to have insurance pay for it. Also, not all hospitals will do it for you.

The pricing is ridiculous, but it’s an option. The facility I work for is large enough to have it’s own insurance company, and so our prices are broken down by medicaid/medicare, in house insurance, outside insurance, and Self pay. The difference in pricing is absurd. The medicare reimbursement is about 50 cents for a CBC. A self payer would be about $54.

We also have a large Amish community that pays out of pocket each time they need to come to the hospital, and we constantly have pricing questions from them. We’ll get questions about how much a Hep B AB test will cost, as opposed to just getting the vaccine in cases where they’re not sure if a patient recieved a vaccine. They’re masters of price comparison in hospitals. I think we could all learn a thing or two from them.

Last point. There are several companies out there. like anylabtestnow.com that allow you to do walk in testing independent of insurance companies and physicians. I think the success or failure of companies like this will be an interesting market research study. It could give a good idea of how ready or willing the general public is to embrace the idea of a free market system.

Being able to choose tests for ourselves, on the other hand, I like from more of an amateur mad-scientist perspective. And, hey, all those fitness bloggers who are now forced to settle for posting shirtless photos of themselves would now be able to post monthly lipid panels, HbA1c, and such as well. But I don’t think the average patient really has a good sense of what testing might be necessary for anything out of the ordinary. Hell, in my experience my doctors haven’t necessarily ordered appropriate testing, and they presumably have a clue.

But after a bit of thinking, I think the point is to reduce utilisation, and make prices more standard and equitable than they are now, rather than effect choice per se. So that makes my point moot.

What is happening in the markets today is NOT the result of a “free market”. We are seeing the result of continual government intervention and manipulation which supposedly is to “level the playing field” but in reality causes unintended consequences which cause even more regulation. Which…umm…causes more unintended consequences. Which…ummm…causes congressional investigations and the creation of new bureaucracies.

Social engineering through market control.

Well, how does an automobile owner know if a mechanic shop is any good? How does a parent know if a tutor or private school is any good? How does a board of directors know if a potential CEO is any good?

There are many life-critical decisions which we make on the basis of limited evidence; what’s so special about doctors and health care?

Matt – I have seen the face of free market medicine in India thanks to some visits with my uncles who are physicians. For those that can afford it care is quite good – in fact it is a hub for medical tourism from Europe with top notch cardiac care including off-pump bypass, etc.

For the masses there are government hospitals – rat infested hellholes little better than warehouses for the dying in many cases.

I’m not saying that would be the system here. But it does beg the point should those poor folks in India be able to sue to the government run facilities for not providing standard of care medicine available to the rich? There is a clear cut double standard in care available so that the poor receive the standard of care correlating to their class. I don’t agree with such a system but it is a free market.

I have no experience working prior to EMTALA – only anectodes and stories from guys that did including some horror stories such as the MI case I posted, or a patient who arrived by private car with a chest tube in place because no surgeon at the nice hospital would admit him, etc.

Good luck finding a politician who is going to support that. Outside of Ron Paul that is.

Were healthcare providers, in some previously unseen burst of energy and dedication, decide to move away from the third party payment model, there would still almost certainly be some base level of care provided by the govt. And that most likely would include the ED, don’t you think?