Health Care from THESE Guys?

I take a certain morbid curiosity in how readily some people are willing to get their health care costs insured by the same people that bring you the DMV, the pre-privatized (1970) post office, the soundly-financed Social Security--and most-tellingly--Medicare trust funds. Remember the last time you fought with an insurance company? If it was your car or homeowner's policy, I'll bet you either played--or were ready to play--the "I'm going to take my business elsewhere" card. Not saying that it's always a trump card, but I can say this: Without it, it can never be a trump card.

How do you threaten your health insurer when you don't get to walk away and take your business elsewhere?

That, I think, is the radical critique that must be applied to any solutions to the current "crisis" in health care. When you have no choice of supplier, your supplier gets, well, surly and ungrateful, especially if you must buy what he's selling and can't sit out the market altogether (remember that when they talk about "personal mandate" health inusrance). I daresay that is as sound a principle of human nature as sex-crazed teenage boyhood, maternal love and flexibly-principled politicians (who at the end of each day justify their flexibility by convincing themselves that anyone else who might forseeably hold their office would be even more plastic, and thus they are rock-ribbed principle-abiders by comparison).

Telling someone to shove their product where it was never intended to go (except for a limited assortment of products too icky to mention here) is the bedrock of a free market and the market is the sphere of our lives in which we exercise freedom most widely and deeply. Yes, you can say most anything except "Fire!" in a crowded theater, while you can't buy heroin or endangered species on some obscure U.N. list, but try standing just one inch on your neighbor's lawn while you advocate the violent overthrow of the U.S. government, and you will quickly find (except in San Francisco or Cambridge, maybe Berkeley and Greenwich Village too) that your freedom is surprisingly confined.

Nothing feels better, after being treated like dirt by some vendor or supplier, than offering a concise business forecast for said vendor that doesn't include your patronage.

Not only does this restore the natural relation between served and server (he who pays the piper calls the tune) with admirable clarity, but writ widely (and often), it is the engine of destruction and creation that Schumpeter identified, the force of nature that drives the constant refinement of service and product to be more pleasing.

In theory, at least, enough employees of a small business can let their employer know that they hate the health insurer he has selected for them, and in theory a smart businessman will at least explore alternatives, but face it: It's only when the employer himself has an unsatisfactory experience with the insurer that change is likely to occur (and then it is highly likely to occur). That's a pale imitation of the mechanism that works with grocery stores, auto repair shops, hairdressing and lawyers, and that it is so washed-out is a fact to be bemoaned and effort devoted to reviving it.

But what happens when the employer himself has a single option; where is the frontier of customer service then?