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...employees are likely to do a better job of monitoring medical care providers—because it is in their own interest—than is the employer or the insurance company or companies.

Friedman really lost it on that one. While most of what he says makes a lot of sense, that one is just pure crap. Is he seriously trying to tell us that individual consumers monitor medical costs better than insurance companies. Has he even heard of how HMO's operate? There are a lot of good suggestions in that article, but I have no idea where he gets this notion that average Americans who know little or nothing about health care will somehow be able to do a BETTER job of aggressively monitoring the health care sector than insurance companies do. That just makes no sense.

Friedman really lost it on that one.

Makes perfect sense to me. If I know I am going to have to pay my medical bill instead of having the insurance company do it, I will start asking questions. "Is this test really necessary? Can you prescribe me a cheaper drug that will do the same thing? Why do you charge $45 for an aspirin - can I bring my own instead?"

The way it is right now, I never see the bill and have no idea how much the charges are. By the time the insurance company sees the invoice, the service has already been rendered and all they can do is negotiate for a discount.

Friedman really lost it on that one. While most of what he says makes a lot of sense, that one is just pure crap. Is he seriously trying to tell us that individual consumers monitor medical costs better than insurance companies. Has he even heard of how HMO's operate? There are a lot of good suggestions in that article, but I have no idea where he gets this notion that average Americans who know little or nothing about health care will somehow be able to do a BETTER job of aggressively monitoring the health care sector than insurance companies do. That just makes no sense.>>>>

That type of argumentation only comes from someone who has never had to deal with medical costs with either a) no insurance or b) a high deductible insurance. I can tell you from personal experience (with both scenarios), you haggle like a Persian rug dealer with the hospital, the doctors, the labs, everyone. You would be amazed at how much freedom there is to move in the pricing of health care. It turns out that the HMOs and the insurance companies haggle as well, they just do it on a large scale (and have some more degree of clout, as they represent much more income to the provider).

I had a high deductible policy when my daughter broke her arm, and we took her to the ER at a local hospital. The orthopod spent 5 minutes (probably less) setting her wrist, and sent me a bill for 1700 dollars. This was JUST for the services of the orthopaedic surgeon. I called him at the ER and said "I understand you are a HIGHLY trained specialist, and I expect to pay you well for your services. However, you are NOT worth twenty thousand dollars per hour, and I am refusing to pay such a figure. I understand Blue Cross has negotiated a fee with you guys for $600 for this procedure. I am willing to start there as a price for negotiation."

He stated right away that those "non-insurance" prices were strictly cosmetic, and inflated because when they had to treat indigents, they could write off higher "losses" and thus decrease the tax burden. He agreed relatively quickly to a fee of $750, which I thought reasonable. Believe me, when the money comes directly out of YOUR pocket, you don't just pay whatever the hospital throws at you.

Yes, the average person could minitor costs better.

People buy cars and computers without knowing how they work. They judge by performance. Same with medical care: you can tell when it's good. One way to judge is if you can get to see a doctor, that is a good sign. If you can't, that means the system is not working.

I have lived (briefly) in a Communist country. The doctors were good, but the system was terrible. I was in Canada last summer: they refused to treat my son's cut head at a local clinic, even for cash payment, because the province we were in had decreed that there be no care for "out-of-country" patients. That is a little item that they don't advertise for potential tourists!

Friedman is right that we are moving in the direction of more fully socialized medicine. The care will get more expensive, and worse, and advances will cease.

The only way to beat socialized medicine is to stay perfectly healthy always, or to have a doctor in your own family. And you better not grow old.