Coming Soon - An Overdue Debate About Free Market Health Care

Today I learned that PhRMA, the pharmaceutical lobbying group, is about to launch a multimillion dollar PR campaign on behalf of free-market health care (see here). Television ads are scheduled to appear soon. (I'm not much of a TV watcher, so if the campaign has already started, I haven't seen the ads.)

PhRMA has reason to be concerned. The fact that Medicare Part D forbids Medicare to bargain over drug prices got lots of negative attention during the campaign. That issue, along with the latest analysis of private Medicare health insurance plans, which reaffirms concern that the Bush administration's effort to privatize Medicare - especially the private fee-for-service plans - may be adding cost without adding benefit (see here), make it likely that the Obama administration will be taking a very hard look at the U.S. health system's reliance on free-market mechanisms.

The debate is not likely to line up as "conservative business" against "liberal government." Businesses like PhRMA and device manufacturers that sell health care services will line up on behalf of the "free market." (I put the term into quotes because the market is obviously not free, as in the policy decision not to allow Medicare to bargain over drug prices!) But businesses that buy health services for their employees may well line up in favor of new forms of regulation. Some businesses may lobby to bring the U.S. system of employer-based health insurance to an end.

My strongest hope is that debate about the health system becomes more evidence-based. Since the Reagan administration U.S. political dialogue about health has been dominated by free market theology - a faith-based belief that a "free market" will by divine ordination drive improvements in value and cost as it does for manufactured goods. But the pendulum is swinging. Less than a month ago former Federal Reserve chair Alan Greenspan, a faith-leader for "free markets," acknowledged with "shock" that his faith that markets would regulate themselves to serve the public good was "flawed."

As I wrote the previous paragraph lines from Matthew Arnold's poem "Dover Beach" popped into my mind:

The Sea of Faith
Was once, too, at the full, and round earth's shore
Lay like the folds of a bright girdle furled.
But now I only hear
Its melancholy, long, withdrawing roar,
Retreating, to the breath
Of the night-wind, down the vast edges drear
And naked shingles of the world.

The global economic crisis appears to be prodding the sea of "free market" faith into retreat. We in the U.S., who have guided our health system by that faith for 30 years, are in for an interesting ride!