Arthur A. Mauceri and Paul A. Alfino: There is no health care free market


Published: Sunday, December 9, 2012 at 6:01 a.m.
Last Modified: Thursday, December 6, 2012 at 11:21 p.m.

In a Nov. 25 Speaking Out, Drs. Christopher R. Cogle and Nancy S. Hardt express their opinions that "The free market hasn't worked for health care." They argue for the immediate adoption of health care exchanges in Florida, set up by the state, as mandated by the "Affordable Care Act" (ACA), aka "ObamaCare".

We would like to offer a differing point of view.

We are physicians in private practice in Gainesville. We make that distinction since Cogle and Hardt, identified in the article as "physicians in Gainesville" are actually physicians on the faculty of the University of Florida. We have a combined 65 years of experience providing health in the private sector in Gainesville. As such, we have directly delivered health care which Cogle and Hardt have alluded to as the "free market."

Clearly, there hasn't been a truly free market in health care in this country for many decades. Medicare, Medicaid, mandatory treatment of patients in the emergency room, the VA health care system, the malpractice debacle and prohibiting payers from crossing state lines are all non-conformities with the "free market." Therefore, the debate is not about the problems associated with "free market health care" but, rather, the problems associated with our present patchwork of free market and social safety-net solutions.

Cogle and Hardt should know this but prefer to use the straw man argument approach by blaming "capitalism."

The authors argue that consumers cannot make informed decisions on health care partly because they do not have access to all of the facts. Others have argued the people are too impulsive or uninformed to make "mature" decisions about their health. This leads to government intrusions, such as New York City Mayor Michael Bloomberg banning large sugared beverages in New York City or low-calorie school lunches mandated by the U.S. Department of Agriculture. The thinking is that if people choose to make decisions that the government believes are inappropriate for them, then, the government should simply mandate the "correct" decisions. This is applies whether the decision is to forego the sugared soft drinks or buy government approved health care.

Could the government at some point compel people to exercise or to take vitamins?

If the only result of the ACA was to increase the proportion of the population eligible to receive routine medical care, then it would be inevitable that health care costs would rise. However, once more people are let into the health care system at the front door, more people will be refused certain aspects of care once enrolled.

The truth is government controlled health care can only bring down costs by limiting access to expensive treatments. All physicians know that we spend enormous amounts of money in sometimes hopeless efforts to keep people alive in desperate situations in which age or disease have already determined the expected unfavorable outcome.

Beyond this, there are treatments that would be successful but will be disallowed because they are not "cost effective." For example, maybe we shouldn't repair granny's fractured hip since she has a history of breast cancer and other medical problems. Maybe smokers or poorly controlled diabetics won't get coronary artery bypass surgery.

Cogle and Hardt assert that government mandated health care will assist people who are unable to make informed decisions for themselves. The irony is that the ACA was passed in secrecy ("We have to pass the bill so that you can find out what is in it": former Speaker of the House Nancy Pelosi, March 9, 2010).

Most people have no idea what is coming down the pike. The level of intrusion in our health care decisions and in our lives will be unprecedented and will be associated with a burgeoning federal bureaucracy.

Ultimately, there will be no real improvement in the health of our patients as a result of this legislation. Only by improving physician-patient relationships at the individual level can we convince patients to make appropriate personal choices for themselves.

Arthur A. Mauceri and Paul A. Alfino are Gainesville physicians.

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