David R. Henderson  

Free Market M.D.

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The doctor then takes a history and physical, spending about 30 minutes with me, for which the flat fee is $50. He explains his hourly billing is $100-much less than a typical lawyer charges, I'm happy to note. He tells me at the end of the evaluation that my problem can likely be evaluated in under five hours of his time, and that the retainer will be $500. I will be billed monthly and asked to replenish the retainer if it drops below $150. I can pay cash, write a check, or use a credit card, but I have money saved in a health savings account (HSA), so I just pay using my HSA debit card.

I do not have to wait to see my physician. He makes himself or his physician assistant (PA, who bills at only $50 an hour) readily available to me. He phones and e-mails to answer any questions I have or to convey health information to me in a timely fashion.

This is an excerpt from "Health Care: A Future Free-Market Alternative," in The Freeman, October 2009. In it, Ross Levatter, M.D. lays out what I found a highly plausible vision of what a free market in health care would look like. Well worth reading.

Sidebar: Ross is also a big fan of Thomas Szasz, whom Bryan is a big fan of also. Here's a piece he wrote on Szasz.


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COMMENTS (9 to date)
RL writes:

Just a note that the Szasz link begins with a review/interview by Dr. Levatter, but as one scrolls down one finds additional material written by other people, including Jim Powell and the late Roy Childs.

Steve Roth writes:

Perhaps only tangential, but might we me not save billions if health insurers were required to cover doctors' time when they interact with patients via phone or email?

It's incredibly frustrating to me--and many others, I'm sure--that I have to visit a doctor's office to get the results of some tests, for instance. And can't call them on the phone or email them.

david writes:
Sadly, some people develop chronic diseases without having obtained insurance. Many of them, who can afford it, simply accept that they will pay more for their health care, just as very litigious people pay more for their legal care. Some can’t afford it on their own, and family or church is often there to support them, as was the case before third-party payers took over that role. In addition, such people often receive pro bono care from a wide variety of physicians who feel offering such free care for a percentage of their practice is both good business and the professional thing to do.

I see. The "if you're too poor, please die faster" solution.

Really, while easing the licensing requirements and forcing doctors to publish their treatment prices is great, trying to quietly sweep the poor under the rug of pro bono care is really unsubtle. And did Levatter forget that people have a right to legal counsel? Paid for by the government? His is a poor choice of analogy!

Hell, even Singapore - which actually employs many of the market-oriented pricing mechanisms Levatter describes - will pay for the poor.

Joe writes:

Already happens in Manhattan;
I would pay a PA 50 bucks an hour if needed (MD is only needed for an actual complex problem)

Most MDs would hate this stem. It places a premium on customer service and marketing to build and maintain a good pool of patients.

The two big problems are:
1) Incetives to MD are greater than before to promote less than medically useful cash additions. (Saw this a lot in med practice consulting. MDs would push their "house" brand of vitamins, same stuff as CVS generic vitamins for 2x as much. And yes, very few people actually comparison shopped, just trusted MD)

Unit writes:

If we want to look into the future shouldn't we look at how the super-rich get their health-care now? Does Bill Gates purchase insurance? What about Buffett? etc....how do they pay their doctors? Do they have someone in charge of their total health?

The Sheep Nazi writes:

ASE certified technicians bill $75 to diagnose your car. I bill twice that, and I'm not an MD or a lawyer. Fix your numbers, and we'll talk.

Brandon Berg writes:

david:
And did Levatter forget that people have a right to legal counsel? Paid for by the government? His is a poor choice of analogy!

As is yours. There is no recognized right to legal counsel. What you're thinking of is the right not to be punished for an alleged crime without a fair trial, one requirement of which is that you have access to legal counsel.

This is an important distinction. It's not that the government has to give you free stuff just because you happen to live within its borders. The government has to give you legal counsel because it wants to harm you, and because it's very dangerous to allow governments to harm people without jumping through a bunch of hoops first.

Allowing the government to run kangaroo cuorts poses a grave threat to a free society. Not requiring the government to subsidize health care, whatever its other merits and demerits, does not.

RL writes:

david (NOT Henderson) believes, it seems, that people have a right to legal counsel. That is simply not true. If you want to get a divorce, set up a corporation, file a will, and most other things that require or benefit from lawyers, no lawyer is provided free of charge. David seems to have confused the limited right to have an attorney provided if you are accused of a crime AND cannot afford one (a limited right in a limited context) with a more general right to a lawyer.

The remainder of his commentary is equally astute.

CJ Smith writes:

Brandon Berg writes:

There is no recognized right to legal counsel.

and RL writes:

David seems to have confused the limited right to have an attorney provided if you are accused of a crime AND cannot afford one (a limited right in a limited context) with a more general right to a lawyer.

Brandon, as RL correctly notes, there is a recognized right to legal counsel in limited situations - the Sixth Amendment to the U.S. Constitution:

In all criminal prosecutions, the accused shall enjoy the right to a speedy and public trial, by an impartial jury of the State and district wherein the crime shall have been committed, which district shall have been previously ascertained by law, and to be informed of the nature and cause of the accusation; to be confronted with the witnesses against him; to have compulsory process for obtaining witnesses in his favor, and to have the Assistance of Counsel for his defence.

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