Freedom and Health Care

After I wrote my recent post on Roots, Episode 4 (see Before the Storms Hit...), I thought about the whole issue of freedom. The slaves did not have freedom, for they were totally subject to the will of their master. They didn't have too many choices for themselves. I compared that to Communist societies, in which there is not much choice in terms of products. People have to get their food from the government. All sorts of things are run by the government, and they can't vote with their feet and buy from someplace else.

And that's why libertarians think that less government means more freedom. When the government keeps out, people have more choices. If there are enough consumers who want something, then the market will provide it. And competition ensures that the market will do things efficiently, since people can always vote with their feet and shop elsewhere. That's not true when there's a government monopoly.

But does it always work that way, and, if not, what am I missing? For example, in America, we have private health insurance companies, whereas the government gives insurance in a lot of other Western countries. How much of a choice do we really have? Insurance is helpful in case we have an emergency, or even in allowing us to maintain our health. But we often have to pay high premiums to get insurance that actually covers a lot. Shouldn't competition be driving down the cost, or ensuring that the companies cover more things (which are mutually contradictory, I know)?

Maybe there are two things that are going on. First, the insurance companies want to make a profit. That's why they don't pay for every single thing. They want money left over for their executives. Still, wouldn't offering lower premiums attract more customers and drive up the profits? That brings us to number two: the companies may not have enough money to cover all of the medical costs. After all, they need a lot of people paying premiums, and that doesn't happen when customers are going to different companies.

I'm reading David Jay Johnston's Free Lunch: How the Wealthiest Americans Enrich Themselves at Government Expense (And Stick You with the Bill), but it's not been as helpful as I'd like in discussing health care. Johnston says that HMOs converting from non-profit institutions to for-profit businesses costs the taxpayers a lot of money, but I'm not entirely certain how that works. I need background information. I wonder if there's a Health Care for Dummies book out there!