Roemer M I, Roemer J E
Int J Health Serv. 1982;12(1):111-29. doi: 10.2190/1EY0-GNUG-7HT1-WLB1.
In recent years, difficulties in U.S. health services have been ascribed to excessive government intervention and regulation; high costs and other problems would be solved, it is argued, by "return to the free market and competition." Examination of the past operations of free trade and competition in health care, however, shows that in this market not one of at least five conditions necessary for effective competition exists. Numerous adjustments made by social reflect strikingly the problems caused by these market deficiencies (such as seriously inadequate information or the presence of social "externalities"). Furthermore, even these adjustments-such as medical ethics or health insurance-have generated serious secondary problems. Many types of waste and social inequity also persist, in spite of all the attempts to compensate for market failure. In effect, the so-called free market in health care has survived only because of the extensive regulations and other actions taken to patch it up. Abandoning these adjustments would further aggravate current problems. Only replacement of free trade by systematic social planning could hope to achieve a health care system that allocates resources and distributes services both efficiently and equitably.
近年来，美国医疗服务领域的困境被归咎于政府过度干预和监管；有人认为，通过“回归自由市场和竞争”，高成本及其他问题将得到解决。然而，审视过去医疗保健领域自由贸易和竞争的运作情况会发现，在这个市场中，有效竞争所需的至少五个条件一个都不存在。社会做出的众多调整显著反映出这些市场缺陷所造成的问题（比如信息严重不足或存在社会“外部性”）。此外，即便这些调整措施——如医学伦理或医疗保险——也引发了严重的次生问题。尽管人们试图弥补市场失灵，但多种形式的浪费和社会不公现象依然存在。实际上，所谓的医疗保健自由市场得以存续，仅仅是因为采取了广泛的监管措施及其他补救行动。放弃这些调整将进一步加剧当前的问题。只有用系统的社会规划取代自由贸易，才有望建立一个能有效且公平地分配资源和提供服务的医疗保健体系。
