Refuting the canard that the existing healthcare system operates as a free market

Ezra wrote:

... there's little doubt that where Medicare leads, the health care industry follows. Private insurers frequently set their prices in relation to Medicare's payment rates. Hospitals are sufficiently dependent on Medicare that a reform instituted by the entitlement program becomes a de facto change for the whole institution, and thus all patients. A process that empowers Medicare to aggressively and fluidly reform itself would end up dramatically changing the face of American health care in general.

If you're wondering why we're in such dire straights, that first sentence should clue you in. Medicare is a giant, dysfunctional federal money hole, but it has such clout that care providers are obligated to follow its lead.

Hopefully a reformed MedPAC, which Ezra discusses, can make it suck less and help technocrats reduce costs. But the idea that we should provide something like "single-payer Medicare for all"—as those furthest left like Kennedy and Kucinich naively desire—is an obvious recipe for continued disaster.

A "public option" creates much the same problems of industry having to follow the government's lead and compete with a subsidized actor—which is why we should avoid creating one.