Entrepreneurship

There was a time when I actually believed that there was a functioning free market in US medical services. Experience has taught me that this is by no means the case.

I may have mentioned before that my wife is opening a primary care practice in Bolingbrook. It’s been a long haul but we’re finally open for business. One of the key matters in any business is setting prices. Here’s how it’s done these days in our “free market” us medical system.

1. Look up your Medicare geographic zone (set by the US Government)
2. Download the price list for that zone
3. Enter those prices in your billing software

There are all sorts of restrictions on price flexibility. Even if you don’t accept Medicare, even if you don’t accept Medicare assignment (ie, you’re not part of the program and the patient gets Medicare reimbursement at home after you’ve taken their money at the office), you still have a “limiting charge” that you’re not allowed to exceed if your patient is a Medicare participant.

You’re also not permitted to discount your prices under certain circumstances. If you accept insurance, cash patients are pretty much forced to pay the highest rates for your services even though they are your most preferred payers (you get your money quickest and with the least cost and fuss).

Clearly, if you can’t set your own prices but are largely cutting and pasting in numbers from a government provided spreadsheet, this situation is not a free market. Yet it’s also not socialized medicine. So what is it?

I’d like to know why we don’t use the inked-finger system to reduce voting fraud in the USA. It’s not like we don’t have a fraud problem here.

In the early 1980s, a couple of weeks after the first election in El Salvador, I met a woman who had voted there. She showed us the ink that was still on her finger and my first thought was: Why don’t they do it that way in Chicago? It wouldn’t eliminate fraud but it would at least make multiple voting much more difficult.

The reason they don’t do it, I am speculating, is that for any given election one party primarily benefits from fraud, the other party usually doesn’t think the battle is worth fighting (and either wants to retain the fraud option or fears the anti-fraud rules could be used against it in the future), many voters also benefit from the fraud, and the voters who don’t benefit are not well enough organized or even aware of the problem. So while voting fraud is a serious problem in the aggregate, it is difficult, at any particular moment, to get a big enough constituency together to do anything about it.

Perhaps the Internet, by facilitating the flow of information and political organization, is increasing political incentives in the USA to do something systematic about election fraud. I hope so.