A lot Advocates of free and spontaneous societies are at a bit of a disadvantage when asked by the opposition just what we propose as an alternative to some tottering example of the inadequacy of planned social order. After all, if we'd all spent the last few generations eating swill slapped in front of us at state-run cafeterias, who would feel comfortable describing a world of gourmet restaurants, fast-food drive-ins, greasy spoons, and ethnic food carts evolving all by itself if we just swept away the federal Department of Heartburn? Yet describe the alternatives, we must, when goggling at the current if-you-like-it-there-it-goes fiasco that doesn't even rate a description as the army-issue shit on a shingle of health care systems. We can't reliably describe what a free society would come up with for treating people's aches and pains given time to evolve and react to human needs, but Obamacare can be improved upon. A lot.
Aside from clearing away the spiderweb of mandates and regulations that have entrapped patients and providers in the United States, many health care experts have proposed less-coercive alternatives not just to President Obama's (not so) Affordable care Act, but to the system on which it's been grafted.
Job-based health insurance is an unintended artifact of World War II's wage and price controls. Employers offered benefits to hold or lure workers when they couldn't adjust paychecks. While the development made sense under the circumstances, it has since guaranteed that leaving a job also means changing health plans.
Such health coverage also means that consumers of health care—insured workers—have little incentive to comparison-shop for lower prices, since they don't pay out of pocket (this is a failing of any third-party-pays system). In a 2010 article for the Ludwig von Mises Institute, Vijay Boyapati described how elective LASIK procedures, which are usually paid out of pocket, declined in cost by 30 percent over a decade even as other covered medical procedures become more expensive. He also detailed his personal experience in shopping around for a dermatological procedure and finding prices ranging from $700 at a practice that accepted insurance down to $50 at a cash-pay clinic.
How to address these distortions?
Writing for the Cato Institute, Michael F. Cannon proposed that Americans gain more control over their pre-tax health dollars. Specifically, he suggested eliminating the tax preference for employer-sponsored health coverage in favor of very large, tax-free health savings accounts (HSAs) giving Americans direct control over their health expenditures.
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