"Free preventative health care," recently  headline news, is a mirage, a pipe dream.  In fact, any service advertised as free does not exist, unless one wants to return to slavery.  In a free society, a person who provides service must do so voluntarily and must be paid, whether that service is dry cleaning, legal advice, or medical care.

In the usual (free) market of American consumers, sellers such as providers of a service determine their own prices in competition with other sellers, all vying for consumer spending.  Thus, the dry cleaner quotes a price per item.  Lawyers disclose their hourly rate.  Consumers then decide whether to spend their dollars, whom they chose to pay, and how much.  That is not how healthcare works.

The U.S. healthcare "market" is centrally controlled — it is not a free market. 

Contrast healthcare to any other market in the U.S.  Sellers of care services — providers — do not set their prices in competition with other sellers.  More accurately, providers can set their prices wherever they wish, but third-party payers — insurance companies and government agencies — determine in advance what they will pay.  They say to providers, take it or leave it.  Price doesn't mean in healthcare what it means everywhere else.  In fact, it is meaningless. 

Providers (sellers of care services or goods) do not compete with one another at all.  In health care, the only price competition occurs between health plans and insurance companies for low-bid contracts. 

Even though patients are the consumers of health (medical) care, they are not the buyers, or more precisely, they are not the payers.  They do not take money out of their pockets to compensate the sellers whose services they consume.  The co-pay patients sometimes pay to providers represents a tiny fraction of the sellers' cost of doing business.  Third parties who pay providers predetermine such payments, regardless of what price the seller might set for care services. 

Thus, patients and providers are disconnected financially.  Without competition among sellers, there is no pressure to keep prices down.  Without consumers who are also buyers — i.e., who pay sellers — there is no incentive to economize.  The end result of supposedly "free" health care is ever-increasing spending and progressively decreasing availability of care — the sorry state in which U.S. healthcare exists today.  

After bemoaning the loss of free preventative health care, law professor Chandler opines that "Congress thought [free preventative health care] was a feature [not a bug] in the Affordable Care Act (ACA) — insulating these difficult decisions from political pressure."  This is truly ironic.  "Congress" did not pass the ACA.  The Democrat party, in control of both houses of Congress and the White House in 2010, rammed Obamacare through without a single Republican vote.  Rather than being free "from political pressure," the ACA was a paradigm of political pressure achieving a one-party power play. 

Let's set the record straight. 

There is no such thing as free health (medical) care. 

Most assuredly, Congress was not free from political pressure when it passed the ACA.  

Deane Waldman, M.D., MBA is professor emeritus of pediatrics, pathology, and decision science; former director of the Center for Healthcare Policy at Texas Public Policy Foundation; and author of the multi-award-winning book Curing the Cancer in U.S. Healthcare: StatesCare and Market-Based Medicine.

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