[Prophasi]

This perception of the US as having a free-market economy, particularly in the area of healthcare, is curiously persistent.

Vast sums of money are spent lobbying to distort the market in favor of particular companies and industries. The FDA has long been accused of preventing key drugs from coming to market that are available in other countries. The patent system alone perpetuates medication monopolies over decades for fabricated reasons, keeping cheap generics out of people's hands. The tax system heavily favors employer-run plans (for reasons rooted in the WWII era) that encourage overspending, tie coverage to your employer, and distort the market in multiple, deep ways.

Medicare and Medicaid are huge. The chart in the FEE link below puts US gov per capita expenditures at 4th in the world.

The below Vox article, which is otherwise anti-free-market, concedes that generic insulin providers seem too daunted by secondary patents and "extreme regulatory complexity," both of which obviously run counter to a free market.

This isn't to say a free-market system would be a panacea of all complaints (systems dealing in scarce resources will never be perfect to all participants), but those complaints would be much different than those about the layers of bureaucracy, high government spending, low competition, high time-to-market for drugs, breathtaking lobbying efforts, and overwhelming tax complexity we have now.

Maybe you think you'd prefer single-payer to the present regime, but to characterize the latter as "free-market" sets up a false dichotomy. (Note that it could logically still be "underregulated," as you say, despite not being free - not that I would agree.)

Drug patents: https://www.statnews.com/2019/02/11/drug-patent-protection-o...

Tax distortion: https://www.forbes.com/sites/theapothecary/2017/07/30/why-ta...

Insulin prices: https://www.vox.com/2019/4/3/18293950/why-is-insulin-so-expe...

Free market? https://fee.org/articles/the-idea-that-the-us-has-a-free-mar...

[howard941]

We had a free market for drugs. So free and freely abused that it gave birth to modern journalism (muckraking) and the Pure Food and Drug Act of 1906. For good reasons few yearn to return to those truly free times.

https://en.wikipedia.org/wiki/Pure_Food_and_Drug_Act

https://www.u-s-history.com/pages/h917.html

[Prophasi]

Thanks for the links - that's interesting to consider when weighing the tradeoffs of an FDA-less country. Of course, the FDA is only one part of the story, and conceding a need for its general existence in no way means that its current purview and methodologies don't need extensive revision.

In any case, my post above was about what is (and what to properly call it), not what ought to be.

[kjdndisneinj]

The free market will always distort regulation to suit the elites that profit from those distortions. Either through government or monopolistic corporations.

As long as private property is enforced through the threat of violence these problems are not tractable. The only solution to regulatory distortion is the complete abolition of capital.

In the case of healthcare, nationalized single-payer system gets far enough for something so critical to our existence without requiring a complete restructuring of the economy.