Former President & CEO, INTEGRIS Health

Market Forces

Published in The Journal Record
September 25, 2019

When my father thought someone, perhaps a neighbor, friend, or relative had too much of anything, maybe money, clothes, cars, he would say, “Bob has more _________ than Carter has liver pills.”  I never had a clue who Carter was, and certainly had no idea what liver pills were for.  Years later when I used that expression on my own children they would often look at me as if I had lost my marbles.

As it turns out, there really were Carter’s Liver Pills.  They were introduced in the mid-1800’s and were so popular as an elixir for conditions as widely varied as headaches and constipation.  Why Carter had too many of these I will never know but they may aptly describe much of the condition of the medical system today.

In a typical urban setting there is an extraordinary plethora of medical devices, with capabilities that are seemingly available on every corner.  There is a saying in the hospital community that there are more MRI machines in metropolitan cities in the United States than in the entire country of Canada.  While this may be an exaggeration there is still a ring of truth to it.

Our technological capabilities are enormous.  Common classical conservative economics say that when any good or service is readily available the market will act to reward the most efficient and lowest cost provider of that service.  Four gasoline stations on a corner drive down the cost of gasoline.  Four MRIs in a corner drive up the price of MRIs.  The reason?  The health care market is not generally responsive to market forces.

The average consumer is subject to the wishes of a physician and is protected from the economic consequences of their decision by generous health insurance policies.  This insurance protection has led to massive availability of the most sophisticated technology and a disregard for price.

The most interesting question is, “What would the health system look like today if the economics of health care were not fueled and stimulated by this insurance largesse?”  my assertion is that it would be significantly less robust technologically.

So, my father may have indeed been right.  Carter clearly had too many liver pills.

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