I've seen that line of logic before on some of the conservative blogs.  The type of health care reform they support is spending accounts, where consumers get a lump sum every year and have to pay for their own medical care out of it.

One of the reasons behind this type of "health insurance" scheme is that if consumers had to pay the real costs of their medical care, they would choose more wisely, comparison shop for better prices, and it would boost competition among health care providers.

The problem with that paradigm is that medical care has grown so complex that it's difficult for even the most well educated consumer to sort out the choices.  Even doctors, when they become patients, can get overwhelmed by the health care delivery system.

Forgive me for sounding like an elitist but I'm not sure consumers would always make wise health care decisions if thye were based only on their pocket books and what they could afford.  

Which tests would they forego?  Mamograms?  Colonoscopies?  

The key to the dramatic rise in the number of patients who survive cancer is early detection.  All those expensive tests save money down the line since cancer caught early is much easier and less expensive to treat successfully. And even more important, lives are saved.

But those tests are unpleasant and it's difficult to convince people to take them. Make them more expensive through "free market" schemes and even less people will go for them.

In addition, I'm not sure I want to see my loved ones looking around for the doctor or dentist who offers the cheapest rates.  How about focusing on the most competent and knowledgeable health care professionals instead.  It's hard enough to know how to pick a good doctor without having to get price quotes.

Sometimes, the business model is not an appropriate one when looking for professional services.  Especially when the health and lives of your loved ones are at stake.

That's the limit of the free market ideology and the limit of the party that is so blinded by it.

by a rigid "free" market philosophy, and health care is one of them, as are many other items in which social or community benefits are of paramount importance. When the compulsion of bottom line profit is relied upon to magically regulate every phase of live, and especially short-term profit is worshipped above everything else, the result is cutting corners, orphan drugs, precarious public safety, toxic food and toys, poorly constructed schools and bridges, and so on---- a kind of Gresham's law in which bad business drives out community welfare.

The profit motive does not necessarily mean greed is dominant in every transaction, but one reason we have government is to "provide for the common welfare," and that means (to me at least) cost benefit analysis must be only one factor to be used to determine how an item is to be treated. Somewhere there have to be rules of the game, protection of the innocent and vulnerable, or we do not have a civilzed society, we have a social system of lawless thugs and vandals.

Isn't it odd that the more virulently free market ideologues seem to abandon free market when it comes to, say, letting no-bid contracts for national security?  

Also, health care spending accounts can't begin to touch the cost of a truly catastrophic illness.  It's not a matter of wise choices or over- or under-treatment.  Often it's a choice of life or death.  That's why we have insurance, to spread the risk of a catastrophic event.

Conservatives cooked up this cynical plan where employers can pretend that they are giving you insurance when they really don't. They call it Consumer Driven Health Insurance; I call it nonsurance.

Getting a lump sum would be nice, but many employers don't do that. Instead, you are suppose to save money into the plan, starting from 0, with the recommendation that you should put a lump sum from your money if you can afford it.

Until you hit the deductible, you are, for all practical purposes, uninsured. You pay sticker prices for medicines and doctor visits. And since they are all inflated because insurance companies pay pennies on the dollars. However, individuals don't get the discounts that insurances get. You use your Health Savings Account, which are non taxed dollars, to pay for that, which is supposed to make up for the difference.

Sounds good? Sort of, until you hit reality (this often happens with conservative policies and schemes.) A medicine that cost $10 under an hmo plan costs $75 with nonsurance. Even taking into account how the money is not taxed, the victim, I mean, the patient is paying more money for that prescription.

The bottom line is this: with nonsurance, you are uninsured with a high deductible. Since the only control over prices we have is to get medical attention or not, most consumers will put off going to the doctor until they really need it.

As with many conservative schemes, they save money to big corporations and has a time bomb built within it which will hopefully explode when the creators are no where to be found.

So HSA/high deductable insurance's time bomb will be a major public health problem if nonsurance becomes the norm. People will put off medical treatment until it is too late and costly. Think the health version of the credit meltdown.