Viewpoint: Is competition the answer?

August 25, 2012

Medical Economics readers discuss whether competition and the free market will really help the healthcare system.

Craig M. Wax, DO, in his editorial "Competition answer to system woes" (From the Board, June 25 issue), was right to suggest that if physicians opted out of insurance companies, true competition would result with an increase in quality and a decrease in prices.

I would add that, in addition, true competition would save medicine from losing its humanitarian roots.

How's this? All physicians within their specialty get paid the same for the quantifiable services they provide. But insurers do not pay physicians for compassion, listening, and talking to patients and making timely consultations. These are just a few of the non-quantifiable services physicians provide, all of which-despite their intangibility-enhance compliance and the healing process.

Clearly, creating a system where physicians can act independently has great potential to recapture medicine's humanitarian roots, without which physicians are merely applied scientists.

EDWARD J. VOLPINTESTA, MD
Bethel, Connecticut

Examples needed

The editorial from Dr. Wax is just a rehash of a plea to have the United States just "free" its medical system and adopt a "free market delivery system" that is so simplistic and lacking in both details and solutions that it is not really a solution.

I am interested to know how Dr. Wax and those who support this plan propose to handle the 15.1% of Americans (Census Bureau, 2010) who live under the federal poverty level (that is more than 46 million Americans). How would Dr. Wax ensure medical care and prevention services to the 22% of all children in America (one in five children under the age of 18) who live under the federal poverty line (Census Bureau, 2010)?

Where is the proof that the free market actually will respond to competition by lowering prices? I have, in my 28 years of practice, seen little evidence of this occurring. In fact, there are many examples of the opposite occurring.

In my community and others, the addition of more and more magnetic resonance imaging machines does not dramatically reduce the cost of such services. Building specialty clinics and small surgical centers, although increasing competition, has had little effect in lowering costs.

If Dr. Wax can show us a real-world example demonstrating his contentions, it might bring more credence to his positions. Short of such proof, let's see whether we can continue to strive to improve the healthcare of every American, not just those with the resources to pay out of pocket for vital services.

MARK ALLEN KLEINMAN, MD
Vancouver, Washington

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