The reason Republicans don’t care how the Congressional Budget Office scores the Republican healthcare plan to replace Obamacare is that they are under the illusion that the free market, if left to its own devices, will come up with ways to lower the cost of insurance and so allow more and more people to keep coverage. Let insurers sell policies across state lines, which means that they will offer policies that are so bare bones as to be useless, but people will have become “free” to choose the plan they prefer. The truth of the matter, to the contrary, is that the idea of the free market failed to explain or prevent other economic problems, like the Great Recession and what to do about the ten percent of the population that probably can’t hold down places in the work force, and the market model is just as wildly inapplicable to medical care. Even back in the days of horse and buggy medicine, when the town doctor could do little but set bones, see you through a bout of an infectious disease, or tell your family that you were dead, doctors engaged in a sliding scale of fees, charging their poorer patients less than they did their wealthier ones, accepting a few chickens as remuneration for attending a farm family. The poor depended on charity wards and free clinics or went without. All this at the same time that late nineteenth century capitalism was developing a system of standard prices openly advertised as such so as to rationalize merchandising. You didn’t haggle over the price in the Sears Roebuck Catalogue. It was different at the other end of the ladder. George Bernard Shaw, in “The Doctor’s Dilemma” shows Harley Street physicians out to make a buck by selling useless nostrums and surgeries for made up diseases to their patients because they could get away with it. Going to a doctor was like going to a spa is today for the self-pampered rich. The best that could be said of it was that it did no harm.



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