Cartoon: Free Market Man in "Health Care Adventure"

As some will remember, I used to have an archive of my political cartoons on Z Magazine, but for some reason Z nuked that portion of their website earlier this year. So I’ve made a new archive, which is located at leftycartoons.com. Please check it out.

My newest Dollars and Sense Magazine cartoon is up at their site. They were nice enough to give me two-thirds of a page to work with this time, so I was able to do a more extended storyline than usual:

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28 Responses to Cartoon: Free Market Man in "Health Care Adventure"

  1. 1
    joe says:

    The criticisms in your cartoons are usually more sophisticated. This seems like attacking a straw man argument…or at least an argument that’s only being made by the lunatic fringe of smaller government crowd.

  2. 2
    Dianne says:

    The best head wound doctors are at public hospitals. This may not be obvious to the average consumer or FMM, however. Which kind of makes you wonder how people are supposed to act as engaged consumers when they don’t even know where to start. (I would have to say that FMM is incredibly unlucky though. Not only did two receptionists not notice that he had an emergency condition that they were obliged to treat or refer for–that is, they should have called an ambulance–but no one saw him on the street and got an ambulance to scoop him up and take him to a hospital (probably a public hospital) after he collapsed on the street. I guess life in Freemarketville or wherever he lives is cheap and people don’t get involved or something.

  3. 3
    Bjartmarr says:

    Hah. Funny. I think I know that guy.

    Though I think the usual scenario is that FMM gets treated without asking the price, then a couple months later loses his house.

  4. 4
    RonF says:

    As Dianne notes, an emergency condition will be treated at any hospital – there’d be no wait at all for a head wound. And as far as waiting for elective procedures (or at least procedures that are not treating immediately life-threatening conditions), from what I’ve heard waiting times don’t improve when medicine is completely socialized, so I’m not sure what the point of panel 5 is.

    As far as choice of doctors goes, FMM can make that choice when he signs up for insurance.

    In the 9th panel, FMM asks why he can’t get health care. But in fact, he can. Nothing is stopping him from getting his head wound fixed at any hospital he walks in to.

    It’s funny, too; here in Chicago if you get shot the word is to take you to County – Cook County Hospital, the quintessential public hospital, passing by some of the world’s best hospitals along the way. When I got my graduate degree at a medical school 2 blocks away from it I was told that the physicians there have more expertise and experience in treating gunshot wounds than Army medics who had served in Vietnam. I would imagine that most inner-city public hosptials have more expertise in treating firearm wounds than any suburban hospital.

    Why the cheap shot at the 2nd Amendment, BTW?

  5. 5
    Myca says:

    Seriously, guys. Sniping about ‘he could go to an emergency room’?

    Way to miss the point of the joke.

    I mean, when people knock on your door, who actually says, “who’s there?” I just go and look, and so does everyone I know! Knock-knock jokes are so unrealistic!

    —Myca

  6. 6
    Brandon Berg says:

    Myca’s right. It’s for Dollars and Sense. It doesn’t have to make sense.

  7. 7
    Myca says:

    Well, no, it makes perfect sense as a broad critique of our current health care woes, just not specifically as a critique of how gunshot wounds to anthropomorphic representations of political ideologies get tended.

    —Myca

  8. 8
    Sailorman says:

    I like the comic but it didn’t make as much sense as some of your others.

    The second line of the comic confused me the most. The belief that the doctors will compete for his business, as a free market principle, is premised on the idea of supply/demand: either a limited number of head injuries in proportion to doctors, or an ability to differentiate between patients based on price.

    So when there are more doctors who want to provide a service than there are potential patients who want the service, the free market makes them compete for patients (Botox treatments, plastic surgery, cosmetic dentistry, LASIX.) Unsurprisingly these tend to be the high-profit sectors.

    And when there is an ability to charge patients more for access, then doctors compete for the richer patients (celebrity surgeons; concierge medicine.)

    However, when the market structure means that there is no difference financially who a doctor takes (e.g. if they all get similar insurance payments) and there is no limit on available patients (e.g. the docs are all overworked) then there is no free market incentive to prefer one patient over another. FMM’s experience is what you would expect in that market. If he wanted to be treated differently in a free market, he would have to provide a different benefit from the other potential consumers. In Line 3, he has that option, and declines it.

    He seems to think the market is broken, but it is working fine. So either FMM is unusually stupid, or he’s a bad straw. In either case, it’s not as accurate as your usual cartoons.

  9. 9
    PG says:

    But the requirement that hospitals treat emergency conditions is itself a product of government regulation, not of the free market. If this guy lives in Freemarketville, where there’s no big bad government telling hospitals what to do, why would the hospitals be required to treat his emergency condition?

  10. 10
    Ampersand says:

    Brandon, it takes me many hours to create a cartoon like this. If a one-line insult is your only response, then I’d prefer you not comment at all.

    I think Myca’s got it right; the critiques by Ron and others misses the point. This cartoon is about why free market principles will inherently fail when applied to medical care; it’s not meant to be a realistic portrait of how things happen in the real world.

    (I suspect Dianne’s response was tongue in cheek.)

  11. 11
    Decnavda says:

    PG is absolutely right here, and it is a point that makes me want to yell at times. I have seen several conservatives battling “socialized medicine” state that people can just go to the emergency room. And I want to ask: Is the ER staffed with elves who work for free using equipment paid for with leprecan gold? SOMEBODY’S paying for it, and if government regulations require people other than the patients to pay for it, then that is a tax on the healthcare system and we ALREADY have, and you are DEFENDING, a system of socialized medicine that provides universal health care. Either state bluntly that you think that some people should be allowed to die because they can not afford health insurance or care, or admit that you agree with government assured universal health care, and explain why you believe the current version of government assured universal health care is better than any proposed alternative.

    Of course, if we admit that we are just arguing over the best system of government assured universal health care, the status quo is doomed, as using ERs for non-emargencies or preventable emergencies is far more expensive and far less effective than virtually any system under which the government ADMITS they are providing universal health care.

  12. 12
    Molly says:

    Right To Bear Arms Man was a cute flourish…

  13. 13
    joe says:

    I think my criticism is that you’ve shown an uncontested flaw in the application of market forces to health care. Yes, a *pure* market system would probably give doctors quite a bit of bargaining power in the case of medical emergencies. That’s why we don’t do it that way.

    I think my take away from this one was
    1. Libertarians are bad.
    2. Our health care system should treat people with emergency conditions before worrying about paying.

    If I were to suggest a revision it would be to have FMM agree to pay cash, since that’s what the market demands, and than show how that impacts his life.

  14. 14
    Sailorman says:

    Massachusetts, where I live, has not yet seen a decline in their ER use to the degree which was expected when they started universal health coverage. I am curious to see how long it will take, and to see if the state can continue to afford it.

    you can read an article on it here:
    http://www.boston.com/news/local/massachusetts/articles/2008/10/06/costly_er_still_draws_many_now_insured/

    this is an excerpt:

    …a sizable number of patients who obtained state-subsidized insurance have continued to use the ER – at a rate 14 percent higher than Massachusetts residents overall, according to state data compiled at the Globe’s request. Those state-subsidized patients with the lowest incomes, who formerly received free care in emergency rooms and now pay a nominal fee, are using ERs at a rate 27 percent higher than the state average. The data excluded patients whose injuries or ailments were serious enough to warrant admission to a hospital.

    Doctors and counselors working the front lines of emergency care say a major reason patients still flock to their doors for routine care is that there are too few primary care physicians in Massachusetts. Some newly insured patients are waiting months for their first visits.

    Healthcare leaders say they also need to do more to connect patients with existing physicians and help them break the habit of heading to the local ER.

    Either state bluntly that you think that some people should be allowed to die because they can not afford health insurance or care, or admit that you agree with government assured universal health care, and explain why you believe the current version of government assured universal health care is better than any proposed alternative.

    Decnevada: You give an either/or: what’s YOUR answer? And do you think that just because we have socialized medicine, you get to avoid the “some people should be allowed to die because they can not afford health insurance or care” question?

    I will state–bluntly–that ANY health care system at a national level will functionally have some form of rationing health care. Any system will involve some patients who want care and don’t get it, and some (hopefully smaller) proportion of patients who need care and don’t get it. It is theoretically possible to provide the highest level of medical care to everyone, but practically it is never done as it is too expensive.

    And any form of rationing means some people will die.

    Of course, systems are different in why they kill people, who they kill, and in how many people fall into those categories. Socialized medicine has different groupings. When done well, it chooses victims (those who are not served) based more on location or luck, rather than, say, wealth or race or gender. And when done well, it also tends to reduce the overall number of system losers. Both of those are good things.

  15. 15
    Dianne says:

    The points that I apparently entirely failed to make were:
    1. Free market man doesn’t even know where to start looking for a good doctor or how to judge when he’s found one (i.e. he doesn’t want to go to a public hospital despite the fact that that’s where the best trauma surgeons are). How can people be expected to behave like rational consumers when they don’t have the basic knowledge to make rational decisions?

    2. In a truly free market health care system, FMM would be left to die on the streets, as he was in this cartoon. Even the “free market” system of the US is not really a “free market” but rather a mixed system. I don’t know of many people who would be willing to take the risks that a true free market health care system would entail, such as being left to die if they happened to be in an accident when they weren’t carrying their insurance card and therefore couldn’t prove that they could pay.

  16. 16
    PG says:

    “ANY health care system at a national level”

    Not just a system at a national level — even a private sector system of HMOs necessarily involves rationing care. I used to work for an HMO. We rationed. We just got despised more for it than governments generally do because when government rations, it’s assumed to be for the benefit of society as a whole (e.g., NHS’s former refusal to provide kidney dialysis for senior citizens was done so there would be enough funds for prenatal and pediatric care). When the private sector rations, it’s assumed to be for the benefit of shareholders (i.e., for profit maximization).

  17. 17
    Dianne says:

    even a private sector system of HMOs necessarily involves rationing care.

    Quite a bit more than the government, actually. Private HMOs have to make a profit. Government based health insurance just has to satisfy the bureaucracy. As a provider, I much prefer dealing with medicare and medicaid to dealing with private insurance companies. The bureaucrats behind medicare and medicaid couldn’t care less if the patient is treated or not or lives or dies, they just want their 14823503/b filled out correctly. Give them that and they’re happy. Private insurers, on the other hand, are motivated to refuse claims: they get more money if they do*. So they are actively trying to block claims. Indifference beats malice any day.

    *A truly well run, long sighted insurance company might be somewhat motivated to process claims efficiently to cut down on the number of complaints about them, improve their company’s reputation, and eventually get more customers. But how many truly forsightful companies do you know?

  18. 18
    Decnavda says:

    I would prefer a single-payer health insurance system. Barring that, I’ll take a universal health insurance scheme that includes private insurance companies but bars them from refusing customers for pre-existing conditions or heirity.

    Yes, any system has to ration. But that does not mean they have to let people die due to lack of health care. My understanding of most nations with universal health care is that they are great at treating life-threatening injuries, and they are also great at prividing preventative care, presumably due to the greater incentive a single insurer has to prevent future cost as opposed to our system, where providing preventative care may mean helping some other company’s future bottom line. Conversly, they are worse with treating the run-of-the-mill non-life-threatening ailments that most people see the doctor about. I suspect this is why some surveys show Americans are happier in general with their health care than most other nations. Most people in America have some form of health insurance, and most people everywhere go the doctor most often for non-life-threatening ailments, so the non-Americans are likely to have more day-to-day frustration with their health care than most Americans.

  19. 19
    RonF says:

    Well, it depends on what you call a failure. In this cartoon, FMM has health insurance. He could choose any doctor he wanted to – he just had to make that choice up front when he bought his insurance. He can still choose any doctor he wanted to as long as he had the $ to pay, but overall FMM was going to survive.

    What you might better use as an example would be someone who has no money and has no healthcare insurance. At some point in a completely free market they would fail to be able to get adequate healthcare and might be injured or die. But that’s not what we see here with FMM. A cartoon of a loyal blue-collar Republican voter who lost his job and then got injured might have made a cartoon closer to your point.

    The idea of a free market, it seems to me, is to ensure a free flow of goods and services between the producers and the consumers so as to optimize the ability for producers to make as much money as they can while competition for the services is maximized. This keeps pressure on the producers to be efficient and keep the prices down. It also encourages producers to raise production and to also look for new things to produce. However, I do not understand it to be a principle of free markets to ensure that all possible consumers will have the ability to obtain sufficient amounts of various goods and services to meet their needs. If you do not have enough money to buy what you need, that’s not a failure of the market. That’s a failure of you.

    Now, a free market in designer jeans can be completely free. Regardless of your teenager’s protestations, nobody is going to die if they don’t have enough money to buy designer jeans. Things like healthcare are different, though. So, as Decnavda points out, in a truly free market, people would die through a lack of adequate health care.

    That’s considered bad. So bad that the country is in broad agreement that a completely free market is unjust. OTOH, we do need some freedom in the market; there’s a reason why most medical advances come from the U.S., and part of it is that you have a better chance of making money on it here than anywhere else (of course there’s other reasons as well). So, here in the U.S., we don’t have a completely free market in health care. We also don’t have a completely free market because of regulation of the supply. You have to meet governmental criteria to provide health care services, to become a physician, etc. Some of that needs work, BTW – it’s my guess that we could educate a lot more physicians in this country than we do if we had more medical schools.

    So both in the supply and demand ends we don’t have a free market in healthcare. I agree with that – we shouldn’t let people die in the streets. So we forbid emergency rooms from turning people away and we have Medicare and Medicaid. When we say “x” number of people are uninsured, that doesn’t mean they can’t get health care. We have universal health care. But for people without insurance it’s liable to be of very low quality.

    We’re never going to completely level out healthcare. Bill Gates is going to get better health care than anyone on this blog, and it’s highly unlikely that any change to that is going to happen in the U.S. I expect that we’ll always have an unlimited ceiling. The question is, what’s going to be the floor? We do have one; it’s not a bottomless pit. We already have universal health care. It just sucks if that’s what you depend on for all your health care. But how high should that floor be? And frankly, what can we afford?

    We just borrowed 800 G$ piled on top of our existing debt (the accounting of which does not include unfunded Social Security obligations). If someone wants to increase the amount of universal health care that we provide, they need to tell me a) how much it’ll cost (using real examples from Massachusetts’ experiment and others), b) what we can expect to get from it (using examples from Canada, England, etc.), and c) where the money is going to come from – how much of it will be taken from other current expenditures and how much of it will come from increased taxation. In the former case I want specifics as to what programs the money will come from and a realistic prediction on the effects on them, and in the latter case I want specifics on who is going to pay how much more money in taxes.

    What I definitely don’t want to hear is that we’re going to increase our debt levels to pay for it. We can’t afford to borrow one more dime.

  20. 20
    Sergio Méndez says:

    RonF:

    Your criticism to the cartoon mises the point: the cartoon is not about how things are (a situation where free market does not exist), but how things will be for free marketers if free market existed (say, for example, if there weren´t public hospitals).

    Ampersand:

    I think your cartoon also mises the point in two points:

    1- The right to bear arms certainly does not imply the right to shoot your neighbor, even accidently. Following a free market logic, the guy who shoot “free market man” would be not only charged criminaly, but also he will be forced to pay to cure “free market man”

    2- You assume that insurances will be as expensive as they are today. But what free marketers argue is that in a free market, without heavy regulation and monopolistic practizes in favor of some insurance companies by the goverment, those will tend to have a lower prize. Left libertarians will also argue that people will find alternatives to organize in mutual aid to pay for medical treatment and care. In fact, that is what they did before the advent of the welfare state and the coorporate sponsored state we have today, in the XIX and the beggining of the XX century.

  21. 21
    Kevin Moore says:

    Barry, why are you using the medium of cartoons to make a satirical point about free market fundamentalism? I really don’t think it’s an appropriate means of taking ideological talking points to their absurd conclusion. Are you trying to be funny? I just don’t get it. I think long-winded blog postings are much more effective. Can I have some graphs and charts, too?

  22. 22
    Mandolin says:

    Barry, why are you using the medium of cartoons to make a satirical point about free market fundamentalism? I really don’t think it’s an appropriate means of taking ideological talking points to their absurd conclusion. Are you trying to be funny? I just don’t get it. I think long-winded blog postings are much more effective. Can I have some graphs and charts, too?

    Dear god, ditto.

    And really, Barry, why must you mock the second amendment? What does mocking have to do with a satirical cartoon?

  23. 23
    Lexie says:

    My first reaction to this comic was LOVE. THIS. And obviously because I got that the GSW to the head was symbolic and A JOKE!

    The comments are interesting here because I think why this health care issue is so difficult is because a lot of people who are basically healthy do not understand the dire situation you can be in when you are catastrophically and/or chronically ill. There is a unrealistic sense of security and confidence that healthy Americans have in our health care system that simply does not exist.

    My partner is a C7 quadriplegic via Spinal Cord Injury and I have vision and hearing issues and kidney disease. I could really write an entire blog about how situations like this and similar really do happen. They are so incredulous they will make your head explode. We call fighting for our health care (and it is a daily fight) “Medical Jujitsu”. My partner especially spends countless hours a day on the phone and writing letters trying to get the basic things he needs to survive and the almost impossible preventative things he needs to safe himself from certain healthcare disasters in the first place. (example: he got a severe pressure sore from being on a standard mattress. He fought insurance to purchase for him a circulating air mattress that would prevent pressure sores. They “rented” him one for ten weeks. The rental price for that long was slightly more than the actual price of the mattress. After ten weeks, his initial wound was healed and they took it back. a few months later, he developed another pressure sore.)

    He could work, at least part-time, but he doesn’t work at all and lives on I think around $800 a month SSI check. Most of the reason he doesn’t work is not due to disability itself but due to this constant medical jujitsu. It literally takes hours of his day. He has three insurance plans. All they do is fight with each other and deny services.

    FMM does take the approach that a lot of people think you can take with health care. That it actually can be workable in the free-market system of supply and demand. That people actually think of health care that way when they are in the middle of a heart attack or have just gotten a cancer diagnosis. And most people cannot pick their insurance company anyway. You are at the whim of your employer (who always goes for the cheapest plan, not necessarily the best product) or are excluded from private individual plans by pre-existings or prohibitive costs. I love how people advocate for tax credits or even health savings plans. Yeah, maybe that will pay for your simple one-time leg fracture. But anything serious, cancer diagnosis, disability, open-heart surgery, etc. and you will lose everything. People have no idea of the costs of long-term health care and how the options are limited by what your insurance is. It is the worst of all worlds. The worst elements of supply and demand jack up the costs, and the worst elements of socialist medicine when people are forced to go to the ER for colds and no preventative measures are ever considered for the uninsured (and everyone else.)

    I get the symbolism here, Ampersand, and this comic is right on.

  24. 24
    Nomen Nescio says:

    Sailorman, every system of healthcare must by necessity ration it. the time and effort of healthcare professionals is a scarce resource, after all; unless doctors and nurses are going hungry for a lack of patients, there’s more demand than supply. given the training and education requirements, i suspect that will always be the case.

    the current “system” of healthcare in the USA rations care also. it deals care out to those who can afford to pay cash on the barrelhead first of all; to those with private insurance second, according to the quality of their insurance plan; to those with public coverage only next; and to those who can afford none of the above, only grudgingly if at all. quality of care tending to decrease as one goes down the list, of course. the problem isn’t that socialized healthcare would ration care out; the problem is that our current system rations it out badly, unjustly and inefficiently, on a basis that makes no obvious logical or ethical sense.

    (and re: the snipe at the second amendment, get it straight please — it’s keep and bear arms, not “bear and carry”. kthxbai.)

  25. 25
    Worried Dad says:

    I put the cartoon up on Reddit. You might want to check out the comments. One thing the free market uber alles crowd doesn’t seem to address is why we would want a free market in healthcare.

  26. 26
    sylphhead says:

    But the requirement that hospitals treat emergency conditions is itself a product of government regulation, not of the free market.

    I have something to add on this. Time and again I hear right wingers bring this up, and suffice to say they don’t even know where they’re going with it when they do. On the one hand, they defend it because it allows them to say that the US has universal health coverage already and that nothing needs to be done. On the other hand, they can see the ideological incoherence between this and their regular stance. Would these people support an arrangement where a retailer of widgets must provide one to everyone who wants one, only to be remunerated indirectly through taxes after the fact? No, they would not, and neither would I, because widgets are a typical market. Health care is not a typical market. That’s what they can’t bring themselves to admit, because once they concede this they suspect their entire position would collapse. (And, you know, they’re probably right; the only question is whether their position is one worth defending.)

    At some point, it’s incumbent to break through the cloud of talking point schizophrenia and just ask, “so, DO you support mandated emergency room coverage, or DON’T you?” You’ll have lost the squackers by this point. From a few of the quicker ones, you’ll hear either that what we have now will do for the interim, or that it’s something they see as a necessary compromise. (Whew!) Well then, can you give us an idea of what comes after the interim? And a compromise by definition is a middle ground between two positions. If this is the “middle”, where is “your” position, exactly?

    Much better than re-posting endless numbers on Medicare’s low administrative costs, I’ll tell you that. Liberals of this generation are so used to playing defense that we often can’t see when a sustained offense is the better strategy. (Sorry I couldn’t find better terms – I agree politics/battlefields analogies are corny and dumb.)

  27. 27
    Joe says:

    And a compromise by definition is a middle ground between two positions. If this is the “middle”, where is “your” position, exactly?

    Well, there’s the position of theoretical purity on one side and the necessities of the real world on the other.
    And as far as interim goes, this will do until somebody comes along with something that will work better. Haven’t seen that yet.

  28. 28
    Tapetum says:

    Joe – so you haven’t seen anything better than lurching-from-crisis-to-crisis universal care yet? ER care is universal health care, all right. But it’s cruddy universal health care that doesn’t actually make most people healthy, but rather patches them into not-quite-dying-anymore status and sends them back out.