Markets cannot be controlled. They can be influenced by regulatory action, but they cannot be controlled. Medicine relies on several government points of influence that existed long before the Affordable Care Act. To practice medicine, I have to be licensed by the state I want to practice in, which is a very arduous and involved process. Although in general it is difficult to lose my license, without it I cannot legally practice. Just thinking about that fact causes me some fear. I have no asset that has any value that generates money – like a machine, a store, or a piece of property. All I have is my knowledge and expertise which, if the government wishes, I can be prohibited from using. Permanently.
Hospitals are the same. In order to have a hospital, it must be licensed to operate and is held to very rigid standards. Hospitals are in less of a bind because the right to operate belongs to the owner of the hospital and if lost, they can transfer all of the assets to a new owner who can resume operation after a period of review.
Now, it seems like this level of regulation should lead to a very regiment system whereby the controls in place produce a very predictable result. Nothing could be further from the truth. In fact, medicine has the absolute lowest level of standardization of outcomes and practices of any major industry. You can talk to several doctors and get completely different recommendations. You can go to completey different surgeons and get completely different operations – and your outcomes may range from tragic to heroic.
Here is where the concept of equality comes in. You see, with the ACA, supposedly all people now have the ability to buy health insurance. As it turns out, it’s pretty crappy and reimburses physicians a small amount of what they feel they deserve. Whether they truly deserve more or not is irrelevant. At the moment, every physician can decide if they want to participate in a given insurance program or not. And not surprisingly, the physicians who can name their price for an operation are not interested in taking what amounts to, in many cases, a 1000% pay cut in order to treat people with crappy exchange plans. Do you have options with your exchange policy? Sure. You can go to the guy who no one else wants to see. Who routinely botches operations, abuses his physician privilege, and knows that you have no other choice. His waiting room will stay full of desparate souls because he is the only game in town.
This is what many opposed to ACA are calling the “two-tiered system” or “multi-tiered system” because while some physicians will be able to demand cash for an operation and may give superior results, other less skilled physicians will give poor results. What those pushing for government paid medicine fail to account for is that you cannot encapsulate the market. You cannot create a world where you control the product you are paying for unless you can successfully ensnare ALL factors that influence it. The next logical step is to REQUIRE physicians to participate in whatever plan – at the cost of their medical license. Many physicians will quit rather than be told how to practice. So the next step witll be to REQUIRE physicians not to quit and to stay at their post. You see where this is going?
The attempt to control a market that many consider critical will ultimately fail unless the people of our country are willing to actually chain the participants to their “responsibilities” and force them to work for a wage that is considered fair. To whom? To the ones paying of course. The ACA as currently structured will either fail or the attempt to make it work will destroy our country.