You see as best I can figure out, you have to take courses from these elite, you cannot select say a different dermatologist because Doctor X is a hack. You cannot select a better lawyer or accountant. As a student you have been convinced that this degree has worth and they you pay based on others decisions. Economics somehow fails the test of the market.
Now for physicians. There is as best I remember no vow of poverty, chastity and obedience in medical school. There was a time when I was in a Franciscan Seminary, but I did not stay, had problems with being told what to do all the time, that obedience problem. So physicians do have to sell themselves. Some are real, well how shall I say it, real jerks, there, it is simple, they may or may not be good, but they are dullards. For many you just memorize the tests and pray you cram through, they are not the ones who asked why. But there is a true market for physicians.
A patient is not forced, at least not yet, to go to a specific physician. They have reputations, for better or worse. There are market decisions made by patients all the time. If a patient has cancer, perhaps they make the market decision of Memorial Sloan Kettering Cancer Center, a long drive, added costs, but most likely a better outcome. There is a decision there, an economic one, even if Krugman fails to see it.
Boudreaux states:
Admittedly, the politically engineered wedge separating the receipt of health-care services from the responsibility for paying for these services creates problems. But the best way to address these problems is to remove the wedge rather than to arrogantly suggest that some mysterious transcendent force will more reliably look after individuals’ health-care needs than will those individuals themselves as they operate in markets in which insurers and physicians must compete for consumer dollars.
I would argue that there are elements of economic decisions already in the equation. The problem all too often is the early stage of decisions that led to a life style choice which causes the disease state in the first place. Obesity, smoking, STDs, drinking to excess, all life style choices and all leading to chronic and possibly terminal diseases and costs. Why not charge for that externality, since as it is we all share the pain.
But back to the argument, physicians are not Franciscans, although some people think they should be. They are also economic animals, and with the costs of medical school, and the way funds are politically distributed to students the results may be less than favorable. Think public school teachers!
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