If this is the best the statists can do we are in good shape.  Dr. Peter Ubel, no Rothbardian, asserts that price transparency could actually increase the price of healthcare (Lasik?) and that while cardiologists and other super specialists make too much money, primary doctors don’t make enough.  

Dr. Peter Ubel, like all  central planners, suffers from the fatal conceit Hayek brilliantly described in “The Road to Serfdom.”  Once again, prices emerge from a free market…they are not imposed.  That Ubel thinks or feels some doctors make too much money is irrelevant and more than likely relates to an unresolved envy issue with which he is struggling, not unlike that Mises dissected in “The Anti-Capitalist Mentality.”  

I wasn’t going to respond to this silly article but there is something to learn, after all.  In response to a question about the free market and price transparency movement we are seeing in the U.S., Ubel says this:

The free market is a wonderful thing, when it enables consumers to make informed choices about which products to buy. But medical consumers, a.k.a. patients, often have a hard time making the kind of savvy choices that will bring discipline to the market. Moreover, they are often in positions of making high-stakes, emotional decisions, in short time spans, without fully understanding their choices. To make matters worse, many physicians I’ve spoken with say they feel it would be inappropriate to discuss the cost of care with patients, especially when they face life-or-death decisions. Hard to imagine how the market, on its own, will work effectively in such circumstances. We need to bring more market efficiency to healthcare, but it is unrealistic to think that a completely unregulated free-market is going to solve our problems. 

Now the first thing to say, is that while he is pontificating and thinking deeply about things, we are doing everything he says can’t be done.  Also, patients are well-informed in spite of his arrogant characterization of them.  

Second, he has contaminated his view with a time twist.  Here’s what I mean.  He is judging the applicability of free market principles in the future, using a current time context.  Here is why that is absurd.

In Oklahoma City, there are car dealerships that are interested in selling you not only your first car, but every car you ever buy.  These businesses have built reputations over time, reputations of fair dealing and thinking long term, not the hit-and-run “gotcha” mentality at some car lots.  Everyone knows who the reputable dealerships are.  The same goes for roofers and plumbers and tire stores and banks and….and now healthcare.  Everyone in Oklahoma City knows that if they need surgery, The Surgery Center of Oklahoma is the place they can go that will treat their pocketbook with respect while rendering the best care.  The same goes for those needing a total joint replacement.  They go to the McBride Clinic Orthopedic Hospital.  The same goes for a colonoscopy.  They go to Digestive Disease Specialists.  The same goes for cancer chemotherapy.  They go to my friend Dr. Aleda Toma and her partners at Cancer Specialists of Oklahoma.  The same goes for mammography.  They go to Breast Imaging of Oklahoma.  The same goes for cardiac disease or surgery.  They go to my friend Dr. John Harvey and his partners at the Oklahoma Heart Hospital.  The same now goes for major gynecological and urological and general surgery requiring an inpatient stay.  Patients will very soon know more about Deaconess Hospital, the latest to join us in this price transparency movement.

Here’s my point.  The reputations of these facilities have taken time to create.  To say that after flipping the switch to free market, people won’t instantaneously know where to go for care, is to disallow the necessary time for discovery of which facilities represent the best value and is logically a cheap trick.  

Dr. Ubel thinks the price paid for healthcare is out of whack.  Here, he and I agree.  Dr. Ubel thinks there is some better way to allocate scarce resources than the free market.  This is where we disagree.  He has nothing to back up his stance other than his feelings.  I think the countless patients we have treated and simultaneously helped to avoid bankruptcy are sufficient to make my case.

G. Keith Smith, M.D.