The free market does not currently work in the medical insurance field

We do not currently have a free market in health insurance, and that is a large part of the issue here. Consumers are separated from the product and the providers by a “health care wedge” of payments from insurers and the government.

In the real world, parents don’t choose their own coverage, and are not in a position to negotiate individually whether they have coverage for breast cancer, broken bones, or autism.

It definitely is a problem that people do not choose their own health insurance. This is a result of the WWII wage freezes and the employer tax break that made including health insurance in compensation packages the wise business move. A better solution to give individuals more autonomy would be to give individuals the same tax break, as explained above.

The “market forces” I’m thinking of can best be achieved by Health Savings Accounts. They are portable and so not tied to an employer, and individuals can choose how to spend their own health care funds. After the high deductible is reached, the insurance can kick in and cover high cost expenses, like autism therapy. People could also insure themselves and their children from future conditions that could potentially increase the cost of their premiums. If individuals are choosing their own health insurance though, insurance companies have a higher incentive to cater to their needs. With the ability to change to another company (as with auto insurance), you would see companies catering to the unique wants of individuals.

In the real world, mandating insurance coverage may increase the cost of insurance a tiny bit (though more effective insurance regulation could avoid that).

“Effective regulation” is as mythical as you believe free-market solutions to be. I recommend reading F.A. Hayek’s essay “The Use of Knowledge in Society,” if you are not already familiar with it. Hayek makes the case that there is no person (or any group of people) able to “know” all of the necessary information in order to properly institute things like effective regulation. Even if it were possible to “know” everything at one point in time, things change so rapidly that the knowledge would quickly become outdated. Most people trust that these regulators have their best interests at heart, but regulators are subject to political forces, too, giving the monied interests an opportunity to affect the outcomes.

The free-market solution does not call for no oversight at all; it just divorces the government from that job. Independent certification could still be obtained. After all, most people would choose an M.D. over a less qualified person, but they could still have the choice to see a physician’s assistant (or someone of lower certification) if they cannot afford health care from an M.D. (In this way, they get something as opposed to nothing.) With competing certification, one would see an improvement in regulation, as the certifying company’s success would depend on maintaining a spotless record, a check the federal government is not subject too.

In essence, free markets are the best way to achieve the ends we all desire: quality with low costs.

My respectful policy disagreement remains, however. Your suggestion that the free market is capable of solving such an issue is, in the complete sense of the word, fantastic. It might work in a hypothetical world where fully informed consumers work with honest insurance companies, but neither of those exists in the real world.

In our all-too-real world, consumers don’t shop for coverage that meets their unique needs, and I’m not sure exactly how that would work, anyhow. Would I be faced with a list of potential maladies and check off those I want coverage for, and those I want to risk “going bare” on? Should my auto policy allow for me to assume the risk of getting hit by a Benz, but protect me from Kias? Insurance exists to cover (mostly) unanticipated risks, so the free-market you conjure would result in chaos, MORE denied claims and an unimaginable mountain of paperwork.

In the real world, parents don’t expect to have a kid with autism. In the real world, parents don’t choose their own coverage, and are not in a position to negotiate individually whether they have coverage for breast cancer, broken bones, or autism. In the real world, insurers cover the first two only because history has created fundamental consumer expectations, and, even there, they do their best to chisel sick individuals by claiming all kinds of crazy exclusions.

Our legislators faced an insurance industry that was refusing to cover a cripplingly expensive syndrome that has been, for unknown reasons, expanding like an epidemic. It has bankrupted families and forced others to go without needed treatment. The free market does not currently work in the medical insurance field, and I hope that you would agree that we are far, far away from the fantastical world of informed consumers and honest sellers that you envision. Even if I agreed with you that such a world would be desirable, in the real world, people are suffering now, and our state legislators do not have the power to create your free-market utopia. Your solution is a fascinating idea, but it is not an honest solution to a very real problem.

In the real world, mandating insurance coverage may increase the cost of insurance a tiny bit (though more effective insurance regulation could avoid that). You are correct that many will incur slightly higher costs, and their only benefit will be coverage that they hope they will never need (you say they receive no benefit, but that’s mistaken). It’s theoretically possible that for some employer somewhere, this could be the dime that breaks the camel’s back, and some people could lose employer-funded health insurance.

But my initial point remains – we can address that problem by excluding coverage for breast cancer and broken bones, right?