Health care reform will inevitably involve some type of subsidy to ensure lower-income Americans have access to vital services. Let’s be honest: they’re receiving those subsidies now, through the least efficient system possible – the billion-dollar shell game of cost shifting, where hospitals and clinics charge inflated prices to insurance companies and people who pay their medical bills, in order to cover the costs of writing off indigent care. We would save vast amounts of money by dealing openly with the needs of the poor, and giving them access to preventive care and diagnostics. The worst place in the medical system to put the needy is the emergency room. It’s bad for their health, bad for the financial profile of hospitals, and terrible for overstressed emergency facilities.

Champions of market-based reform should also remember that health care is a somewhat unique commodity, in that consumers will never see themselves as truly informed buyers. Most people will not be able to get behind a health-care system that requires them to become medical experts. Competition is desirable and has a role in keeping costs down, but it can never be quite the same as the competition that exists between car dealerships, or fast-food restaurants. People are terrified at the thought their lives will depend on their knowledge of medicine. They will desire guidance, which the current insurance system provides by giving them a choice of approved providers in their area. Perhaps a network of carefully qualified primary care providers could offer wellness and diagnostic programs, to be paid for with pre-tax dollars kept in a medical savings account – supporting good health practices in the best way possible, by keeping government’s hands off the dollars set aside for it.