But that's nonsense. When you buy a car, must you be an expert on automotive engineering? No. And yet the worst you can buy in America is much better than the best that the Soviet bloc's central planners could produce. Remember the Trabant? The Yugo? They disappeared along with the Berlin Wall because governments never serve consumers as well as market competitors do.
Maybe 2 percent of customers understand complex products like cars, but they guide the market -- and the rest of us free-ride on their effort. When government stays out, good companies grow. Bad ones atrophy. Competition and cost-conscious buyers who spend their own money assure that all the popular cars, computers, etc. are pretty good.
The same would go for medicine -- if only more of us were spending our own money for health care. We see quality rise and prices fall in the few areas where consumers are in control, like cosmetic and Lasik eye surgery. Doctors constantly make improvements because they must please their customers. They even give out their cell numbers.
Drs. Dyer and Gawande don't understand markets. Dyer's elderly woman wouldn't have to haggle over price before surgery. The decisions would be made by thousands of 60-, 40-, and 20-year-olds, the minority who pay closest attention.
Word about where the best values were would quickly get around. Even in nursing homes, it would soon be common knowledge that hospital X is a ripoff and that Y and Z give better treatment for less.
People assume someone needs to be "in charge" for a medical-care market to work. But no one needs to be in charge. What philosopher F.A. Hayek called "spontaneous order" and Adam Smith called "the invisible hand" would make it happen, just as they make it happen with food and clothing ... if only we got over the foolish belief that health care is something that must be paid for by someone else.
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