When Elected Officials Don’t Get It, We All Pay the Price

Indiana Governor Mike Pence is adamantly opposed to the expansion of Medicaid in Indiana, despite the fact that his opposition will cost Hoosiers a lot of money–not to mention lives.

I have previously explained why our stubborn refusal to participate in this particular aspect of the Affordable Care Act is irresponsible, inhumane and costly.

When Pence announced his negotiated one-year “deal” with the federal government to continue “Healthy Indiana” in lieu of expanding Medicare (a “deal” that leaves some 400,000 Hoosiers without healthcare), he insisted that “Consumer driven healthcare is the path to the future.”

Sorry, Mike–but if that’s the case,  the future is pretty damn bleak.

Here’s the problem: markets work incredibly well when buyers and sellers operate on a level playing field. They work especially well when consumers are looking for widely-available goods and services, and can compare prices and quality and shop around for the best deal. Economists define a market transaction as one involving a willing buyer and willing seller, both of whom are in possession of all relevant information.

That description does not remotely apply to medical care.

The “consumer” who needs a hernia operation is highly unlikely to be in a position to shop around. He’s much more likely to need immediate care, and be locked into using a particular provider by his insurance company. And he is highly unlikely to know as much about the procedure as his doctor.

For that matter, this “consumer transaction” isn’t going to be negotiated by the patient and his doctor. The real parties to this transaction are the doctor and the health insurance company–and as recent news reports have reminded us, the needs of the patient are rarely front and center. (The Star recently reported on a lawsuit brought by the widow of a man who needed a pacemaker–despite the urging of his own doctor and another doctor who was consulted for a required “second opinion,” the insurer delayed its approval, and the man died. The doctor insists that, had his patient had a timely procedure, he’d be alive today.)

There is no market in health care. There never will be. Hernias and heart attacks aren’t widgets and mousetraps; there is not and cannot be a level playing field where consumers have as much information and power as their providers–or where their providers have as much power as the insurers. Other countries have figured that out. And in those other countries, amazing as it may seem, big bad evil government has turned out to be more protective of patient needs than for-profit insurance companies beholden to their shareholders.

To suggest that “consumer-driven” healthcare is the future is to display profound ignorance of market economics.

I think it’s interesting how many “free market” ideologues like our governor have no idea how markets really work.


  1. Sheila; I have to disagree with you on your final comment. Idealogogues like our governor certainly DO understand how markets work – including the health care market. They simply do NOT care; there is no money to be made in serving the people they are elected to represent and protect. If “we”, the state of Indiana, expanded Medicaid there would be less tax money to erect cricket fields and now to repair and install safety measures in Lucas Oil Stadium. Yes, they do understand fully or they would not be able to find ways around providing necessities such as public eduction, public safety, a safe infrastructure and health care for those who need it most. They are not stupid – they are uncaring, greedy and full of self-importance beyond our understanding.

  2. Further, there should be no private market in health care insurance. If Americans still hold that life, liberty, and the pursuit of happiness are our unalienable rights, then health care must be managed as a public good, so that all citizens have equal access to exercise those rights. Basic democracy, labeled socialism in Indiana.

  3. As a RN now going to school for policy for the exact reasons you pointed out, the case regarding the pacemaker is not new and not uncommon. Death panels? We already have those….I worked tirelessly or rather argued tirelessly when insurance and Medicaid when they were denying medications for patients. The alternatives they gave were actually against FDA recent rulings. The latter half of my career I worked with children and we are not putting children on some of the medications that Medicaid and insurance companies were suggesting like Moban and thorazine. When they deny medicine coverage it is not a suggestion and I would often call them out for dictating and prescribing medication w/o a license.

    I had a girlfriend w/ congested heart failure and her doctor recommended a certain pace maker w/ a defibrillator which was denied…she had to wait a year w/ several acute hospitalizations of heart failure before insurance decided she needed the defibrillator; she could have died several times and almost did.

  4. The Governor is playing a political game to enhance his future . He cpuld not care less about the health of the citizens or how care is delivered or paid for.

  5. There’s a bit of free market. I just got my first meds from Canada at fraction of the price I was paying here.

    Maybe a single payer system will eventually win in the free market.

  6. I don’t understand how folks can describe themselves as pro-life and deny health care coverage to 400,000 children and adults – especially when the Medicaid portion will be 100% funded by the federal government for a few years and after that, 90% funded. If Indiana doesn’t use those funds, other states will. We just won’t gain our fair share – a lose-lose situation for Hoosiers needing coverage and for our taxpayers.

    Health insurance didn’t become such a contentious issue until it became for-profit, and then
    problems like caps and non-coverage of pre-existing conditions became the norm. Higher administrative costs and a smaller portion of premiums going to claims also resulted. Patient care takes a back seat to profits.

    It’s estimated that 30 million more Americans will be covered once Obamacare is fully implemented. Given the concentration of insurance companies in Indiana, that’s a job creator for our state. It’ll take a lot more insurance company employees to process all those premiums and claims.

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