All through the land we hear the clarion call of the “free market” faithful:

“Keep the government out of health care. The free market will provide.”

These people even have an “invisible hand” that they believe descends from the capitalist heavens to guide the market into perfect harmony.

The problem with this is that markets are situations where the goal is for parties to accumulate more of what they need or desire at the expense of another party or parties who would then wind up receiving less of what they need or desire. You negotiate down the price for bananas and you get more but the banana dude gets less than he initially wanted from you. Because markets are predicated upon this system of rewards and punishments, parties inevitably will make moves to increase rewards. They will use their power, essentially, to increase your punishment. That these expressions of power by players in the market are not officially called “government” does not matter. Actors in the market who have amassed enough wealth to manipulate the dynamic of their marketplace transactions to their benefit are not doing anything objectively “better” than what a governing body would be doing in regulating the market.

Wealthy market actors such as insurance companies and pharmaceutical companies regularly use their wealth and power to do things that will increase their rewards at the expense of punishing the other parties in their transactions. They do this both by tapping their resources in the government and bribing corrupt politicians, but also through bureaucratic moves like repeatedly denying to pay for necessary medical procedures in the case of insurance companies, and pushing addictive drugs like opiates and xanax in the case of pharmaceutical companies.

The point is that power exists in even the most “free” of markets and that power will be used to effectively punish less powerful actors. No “invisible hand” will be able to remove this dynamic. It will always be a factor.

So what is the answer? In terms of how to deal with health care, the answer is to start envisioning health care as something better dealt with in the realm of cooperation than in the realm of competition. It is purely a fancy of some people’s religious faith in free market ideology that health care is best left to the marketplace. That we’d allow our health to be subject to this system of market rewards and punishments, knowing that powerful forces are using whatever tools at their disposal to transactionally punish us, is not only absurd but also dangerous.