So what happens if the fire department near you doesn't take the insurance you have? What if one of the firemen takes your insurance, but another doesn't and they both come to your house and put out the fire? Do you pay the one who doesn't take your insurance out of pocket? I guess you have to call them weekly to make sure their arrangement hasn't changed. What happens if you can't afford the insurance and a fire happens? Do they put it out and then bill you the $150k or whatever the "non insurance negotiated" rate is? Or do they just watch it burn with your kids inside? How about if the premium hose they use is considered a non-necessary expenditure by insurance, so insurance won't cover the cost of it, is that something you pay out of pocket for? This is all starting to sound pretty complicated for an emergency service.
And what about police? I guess private police forces are the way to go too. As long as the people who took you hostage are negotiating with police, you can just ask for the phone and start negotiating yourself (and calling around if you don't like the pricing). If two people are in a traffic accident and have different police forces, whose gets the final say on the at fault party? Rock paper scissors? Shootout?
Sure, isn't that what essentially happens now, do police officers have jurisdiction everywhere? I feel like your analogy is confusing police, law enforcement, with laws. Remember, this is already well underway. Private security outnumbers public security forces by 5-1.
If the local taxpayers stopped paying for a police department, they couldn't run their cruisers on good intentions. Happy thoughts wouldn't keep the lights on. Benevolent deeds don't put food in the bellies of their children. That's the entire idea behind a public good, you sacrifice innovation, efficiency, prosperity for something you consider to be good. It's a net loss to society to provide that safety net because there's nothing pushing costs (taxes) down like competition and a profit motive does for private industry. And the public argues about that loss, which is why government agencies have been attempting to emulate private industry for decades to deliver better service at less cost to the taxpayers.
Of course they couldn't run them on good intentions. Public goods do not necessarily require a sacrifice of any of those things to be good. Where did that come from?
Say I'm traveling in Chicago and get mugged. What police department do I call? Do I pay them cash or do they bill me after the fact? If my wallet got stolen does that mean I'm screwed? If I get in a car wreck whose police department do we call? Mine or the other driver's? Both? That doesn't seem very efficient now does it? Double the resources for the same situation.
I understand where you're coming from with government inefficiencies, but to pretend that private enterprise only drives prices down is absurd. Internet is a great example. TWC, AT&T, Comcast, etc are all supposedly "competing", yet just divvy up areas and charge whatever they feel like. That's even something you can shop around for!
There are numerous articles around about how expensive things like aspirin or IV bags are in some hospitals. I worked at a place that made saline IV bags, we sold them for <$1 apiece to distributors. I remember it was a huge deal when we raised the price by $.05, we actually were threatened to lose some customers. I read an article while working there about someone who was charged $700 for one at a hospital. Not a government run clinic, a free market American hospital that should be innovating and driving down prices. Who in their right mind would go to a hospital when an IV bag costs $700? Someone who's dying and has to go. I wonder what Medicare pays for a saline IV bag? Or what the Canadian system pays? I bet it's not $700, yet plenty of facilities accept those prices. Then there are ibuprofen that cost $2-3 each. The list goes on and on.
Emergency healthcare cannot be an effective free market, because there is not an ability to take your time and shop around for a low price. The ability to pick and choose who you purchase from is ESSENTIAL to the free market cost control that we're all so fond of that works great on computers and oranges.
I feel uncomfortable wading into this emotional thread. It does not really match the Topic title at all.
Two quick points:
1. If you get mugged NOW who do you call? The police. Okay. What do you expect them to DO? What are the actual chances of getting your money back or catching the guy?
How many muggings actually get solved? My coworker was mugged, in Chicago no less, 2 years ago. Chicago never caught the guy, and never got his money back.
Government can't make life perfect anymore than the private sector can. And you can't solve "poverty" because poverty is a subjective target. And a moving target, too!
2. Emergency care is not the bulk of healthcare expenses. Prices are typically bargained down by insurance companies. There are feed-back mechanisms in place to mitigate these types of practices.
Also, the majority of hospitals in the US are actually non-profit, so who cares? Except that a lot of medical care doesn't even occur at hospitals, and even if it is in a hospital setting, the relevant price-setter is the doctor, who is operating OUT of the hospital.
More broadly speaking, the US system is overpriced, but it is still a great healthcare system. You need to compare it to the 190+ competing national health care systems. Also, the US system has a lot of variation. I prefer my local hospitals to whatever they got out in North Dakota.
Also, you can't just import a healthcare system from another nation. Like, look at how long it took JUST to implement ICD-10. And you want to change the whole healthcare system? Overnight?
If you can, go ahead and do it. At all levels combined, the US government already spends more on healthcare than most European nations. You already have all the money you need.