Much has changed. In a post for the Mises Institute, "Do We Have a Free-Market Medical System"? Hunter Lewis notes that for some observers, profit based healthcare "should be outlawed", while others are upset that healthcare is "socialized". How to think about this? He writes:
So what do we have? I think the most apt description would be "crony capitalist" medicine, one in which powerful special interests conspire with government officials to create legally mandated monopolies, with the specific goal of thwarting free market competition...There are many honest and dedicated medical professionals sincerely devoted to the healing arts. But they are trapped in a system that can more accurately be described as a crony capitalist nightmare.Granted, while healthcare in the U.S. is hardly the result of a vast conspiracy theory, crony capitalist medicine does describe a relative default position, for knowledge use protectionism. This approach has undermined legislation time and again, which possibly could have made the system more accessible and efficient.
Nevertheless, physicians have lost some of their hard won autonomy in recent decades. The added healthcare value they worked diligently to create, is now shared by hospitals, insurance and pharmaceutical companies. However, at a macroeconomic level, a symbolic focus on physicians remains relevant, for their earlier twentieth century successes have shifted the relative value of other human capital representation downward somewhat, in general equilibrium.
How so? Physicians increasingly expressed a preference for a customer base which was only partially representative of general equilibrium. In other words, they increasingly catered to clientele who were the most advantageous to serve. Through a focus on wealthier patients, physicians were ultimately able to raise the status of healthcare to that a respectable profession, on a par with other highly skilled professions.
For physicians in the U.S. healthcare is still largely a free market, in the sense that many physicians remain free to choose both their patients and the services they wish to provide. The problem of course is that this circumstance is one sided, since too many rights to the use of practical knowledge are now limited. Consequently, here's where any semblance of a free market for healthcare starts to break down, for citizens lack means to pursue healthcare options outside the services of today's physicians. Production rights need to be restored so that citizens can once again improve their lot through their own efforts, which is all the more important when they lack the monetary means to reimburse skills which require high levels of investment and sacrifice.
Again, physician discrimination for the use of one's scarce time, is understandable. That's a form of discrimination which - given the scarce reality of our time - all of us have little choice but to employ. Just the same, we need to extend that freedom of our time preferences both ways. In particular, it would be cruel for the physician to discriminate, if he or she does so in ways that deny others the ability to help themselves, especially when no one else can reasonably be expected to come to their aid. First, let's do no more harm. Why not think twice, before we needlessly tie the hands of those who otherwise might discover not only means to help themselves, but also others as well.