Hawaii and the free market

Hooray for Hawaii! Apparently they have managed to get employers to cover just about everyone with adequate health insurance and their health insurance costs and other markers of health care efficiency are marvelous. Could it be the sea air?

http://www.nytimes.com/2009/10/17/health/policy/17hawaii.html?em

So I am brought back to the dilemma that keeps popping up in the health care debate. Can we submit the business of caring for peoples’ health and diseases to market forces and bring down costs? As long as health insurance continues to protect people from exposure to the real costs of things, I don’t see market forces adequately coming into play. Only if health insurance companies actually acted like consumers would that really happen.

Why are medications so incredibly and jaw droppingly expensive? Especially ones for diseases like cancer and transplants and severe diseases? Because people who have those conditions are ALWAYS insured, or else they die, and are not part of the equation. If they don’t start out insured, they become insured when they run out of resources and go on public assistance. So drug companies know that they will be pain the 10 or 20 thousand dollars a year or a course for whatever new and necessary drug is prescribed. If consumers had to pay for drugs that were this expensive, they mostly would not, and prices would have to come down for the pharmaceutical producers to sell their products.

Coming back to Hawaii (which is always pleasant) we see a system that works by covering everyone with health insurance. It reduces costs by keeping the insured out of emergency rooms, cared for by doctors who know them, and by reducing use of procedures because the culture in Hawaii tends to avoid them. But the costs of those procedures and drugs etc. are still amazingly high, and they are successful only in comparison with the rest of our country.