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How health care consumption often works, from commenter KJ:
My wife wanted to go to the dentist in our new city. She's gone to the dentist yearly for years. No problems. This new dentist won't do any procedures because she reports a heart murmur on the forms. She is informed that she needs to get an echo cardiogram by her doctor to see if she needs pre-med antibiotics before any minor dental procedure.She does it. It costs about $1200 which my insurance paid. I paid $10 (I have great employer paid insurance). She didn't want to take off work, didn't feel like she needed this done, and as it turns out doctors have never been able to prove that these pre-meds do any good anyway. But of course, this isn't really a choice in any way like Jacoby fantasizes. The dentist won't put a filling in without a note from the doctor. The doctor wouldn't write a note until she got an echo cardiogram.If the desk lamp purchase would have required an echo cardiogram, I would have not purchased a desk lamp. But teeth and health care are situations where people tell me what I need.A couple things to keep in mind about this story. KJ's wife did not "want" an echo-cardiogram. She was told to get one. It's possible that the pricing could have been restructured such that she couldn't afford to have followed that advice, but that wouldn't have changed her decision making. It simply would have changed her options. And then she wouldn't have been able to get a tooth filling, and would probably have needed an eventual root canal, and would have still needed the echo to get the root canal, and so would have had to pay for both with debt, and so the cycle continues. Health care is a sector where consumers are told what they need. Markets need information, and the folks with the information are the doctors. Health care, in other words, is a mediated market. If you want the "market" to work better, you need to focus on the folks who actually make it work. The problem is not in what consumers "want," but what they are told they need.
