How a hardcore capitalist views the health care mess

In the December 12 issue of Barron's (Shooting the Moon), Editorial Page Editor Thomas Donlan takes a crack at a solution to the financial crisis facing the US health care system. The first half of the article describes the crisis that readers of this blog are already familiar with. And then he says:

At this point, we would like to unveil the perfect solution, a free market that will deliver good care to everybody without relying on the subsidies, tax breaks, bureaucracy, price controls and oppressive regulation of providers and insurers that mar the current excuse for a health-care system.

But alas, he realizes it's not possible.

A free-market system is no more likely to provide health care to everybody than a government-operated monopoly is likely to provide excellent service and the most advanced care.

To have both excellence and universal coverage, we must embrace inequality, a much-derided feature of the system we have now.

We need charity hospitals and charity clinics, but with assured funding and rigid financial discipline to provide limited but adequate care at a price that local, state and federal governments can afford.

Those are provocative thoughts, but not likely to be politically acceptable or operationally feasible. (For example, how will we make sure these facilities recruit doctors that are 'good enough' but not too good or too bad, and that they will use the 'right' amount of technology rather than too much or too little?)

But all is not lost. The article doesn't consider the efficiencies the health care system could generate by applying industrial engineering principles, unleashing consumers' well honed shopping skills, and sending some of the work overseas. In my view, some combination of these is more likely to work.