Two interesting problems.<p>One is that a free market might result in &quot;better&quot; purchaser decisions, but a free market requires a meeting of the minds and some patients won&#x27;t have minds, temporarily or permanently, and those that do have a staggering power imbalance of one uneducated untrained individual vs a thousand person highly trained organization.  We&#x27;re not talking about two commodity traders exchanging with each other.  This is before we get into &quot;state of mind&quot; and panic, someone having a heart attack can&#x27;t focus on contractual negotiations quite like the guy across the table not currently having a heart attack.  And then there&#x27;s the timeliness issue, and geography...<p>The second, is medical care cannot be treated as a commodity.  I was horrified at the &quot;taylorism gone wild&quot; in the article where one surgeon used twice the bandages as the other, and therefore is bad.  In the real world that will be implemented as &quot;well, yes I know your tumor was a completely different size and shape than his tumor, and bandages cost almost nothing compared to a human life, but we have beans to count and quotas to stay under so you&#x27;ll just have to bleed to death because it would take too many bandages to save your life&quot;  or &quot;well yes half his patients are permanently crippled and none of hers do, but she uses twice as many band aids, so we&#x27;ll have to downsize her and keep him, to stay under our bandage budget&quot;.  Without a commodity of interchangeable identical product, you can&#x27;t have a free market or at least not the gains of a free market.  Its interesting that the medical system admits as such... there are specializations of patient disease clusters, but despite the best efforts of centuries of work we still can&#x27;t specialize beyond a very shallow level, we have cardiologist specialists not specialists in 25% arterial blockages of the left ventricle, even though its &quot;obvious&quot; that if it were implementable, specialization to that level would be very helpful.  This is before we get to the issue that you get what you count, so if you count meaningless metrics you&#x27;ll get excellent meaningless metrics, not health care.<p>A better model for the economics of health care would be fine art.  Or maybe education.  Notice how the money spent correlates strongly with how much money is available, and has little correlation with results, at any level beyond bare requirements.  Or how attempts at taylorism style management provide laughable comedy results.  Health care does seem to &quot;fit&quot; better with fine art or education, than with accounting or a manual factory assembly line.