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My recent post, Journalists Fail when Reporting on Medical Care, prompted the following reply from the journalist who wrote the article I critiqued:

"I appreciate your . . . observations. I also appreciate how expensive health care is, which is why I wrote the series in the first place. You'll recall that the consumer-driven piece used two extreme examples -- Austria's price labelling (sic), and Dr. Fickenscher's uninsured surgery. If consumer-driven health care is going to work, it will have to be somewhere in between those examples."

I sent him the following reply:

I appreciate your reply; however, the questions I raised clearly show that consumer-driven healthcare can't possibly work. It relies on two things--shopping around and healthcare spending accounts.

However no one has said just how much money a family would need in a healthcare spending account to guarantee its ability to pay for healthcare. And no one has asked these questions either: What happens if a large number of people buy into this scheme and find that they do not have sufficient funds in their healthcare spending accounts to pay for the healthcare they have received? Are we then going to allow providers to place leans on their homes or garnish their paychecks? And what if that makes families homeless or parents unable to provide adequate sustenance to their dependents? Either could result in a social disaster. Consumer-driven healthcare is a scheme fraught through and through with uncertainty and can only result in a reduction of the availability of healthcare to Americans. Furthermore, it does not in any way guarantee a reduction in costs.

To understand all of this correctly, you really must put numbers to the claims and do the arithmetic, and no one advocating this scheme has done that. The reason they haven't? They know it won't work.

All this scheme amounts to is a surreptitious attempt to put the misplaced belief that competition reduces prices into effect in the healthcare system. Texans should know better after the fiasco involving deregulation of the electricity industry and its horrendous effects. Any close student of market-driven economics knows that competition only reduces prices if supply exceeds demand. So if healthcare is a scarce resource, as your piece states, that condition can't be met. The only people to benefit from such a scheme is the companies that provide, as part of an employee's compensation, a contribution to their employees' health insurance.

Theory may sound good, but without hard numbers, they can't be evaluated. Those advocating this scheme should be made to provide the numbers, and if they can't, these people and their ideas should be repudiated. Otherwise, a great deal of harm may be done to society. I also would like them to tell us how people are going to be expected to shop around when confronted with a medical emergency. If you ask, you'll discover that they can't tell you. They do not care whether the plan can ever work. But they know that if they can get enough of the right people to support it, their own financial positions will be enhanced at the expense and health of Americans.

There is a maxim that all people, but especially lawmakers and journalists, should always ask about any proposal: Who stands to gain? The answer always reveals the true motivation for the proposal. Clearly, consumers will not gain if a consumer-driven healthcare is a scheme is put into effect. That should make us all suspicious. (12/6/2006)