it’s the worst of both worlds. I dont care which way we go…. we just have to get off the fence. socialize my income and expenses….. or keep free market expenses but let us charge what the market will bear…. not what some random fee schedule that the government pulls out of the air.

It does not follow that a free market will lead to more decision making by patients or an improvement in care. Free markets work well when buyers and sellers of products and goods compete freely for services/products in a transparent market where knowledge is open to both buyers and sellers at a place where transacations are once and done deals, and where the products/services are produced by the seller and consumed by the buyer. In medicine, patients don’t know what they want or need (that’s why they need doctors), care can be ongoing, and costs can escalte quickly even when pursuing the most conservative treatment strategies. Free markets in medicine work with patients who have expendable money and in areas that are “lifestyle” procedures (i.e. Lasik, cosmetics). Insurance works in part because it spreads financial risk; the question for medicine in the US is how to contain costs (if it did not cost so much, the political will to change medicine would not exist. Most other discussions, including the compensation of physicians, overal public health, would not have enough political force.) Politics will always make a difference in medicine– no other large first world country has delivery of medical care outside of government control, either directly via single payer or indirectly via tight regulation and control of insurance markets.

That’s like saying the auto industry is in fine shape because people are still buying Lexuses.

That both collect the same (or close to the same) is reason enough why you can’t find a PCP or a surgeon in small town USA.