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Choice Overrated, Visiting Economist Finds

IMPORTED: www_commonwealthfund_org__usr_img_edwards100x100.jpg Comparing her first experience navigating the American health system with a visit to Baskin-Robbins"—that ubiquitous purveyor of "31 flavors"—a British health economist asks, "Can we treat health care like ice cream? Does more choice raise collective society benefit or well-being?"

During a year spent in Seattle as a Commonwealth Fund Harkness Fellow, Rhiannon Tudor Edwards was "overwhelmed" by the choices offered among coffee, TV channels, and health care options, she recounts in her essay, "Blind Faith and Choice" (Health Affairs, Nov./Dec. 2005). But when Edwards, who teaches at the University of Wales, developed a serious sinus infection, she had trouble finding a doctor who would agree to accept her "comprehensive" health insurance and schedule a timely appointment.

Edwards eventually visited a clinic that accepted walk-ins—not so much as a result of informed choice as of immediate need.

Proponents of the individual health insurance market and health savings accounts promise they can provide consumers choice among health plans, providers, and even treatments. The invisible hand of the competitive market, they say, can balance supply and demand. But as Edwards notes, this scenario only plays out when consumers are fully informed, goods or services are homogeneous, and there is free entry into and out of a market. At present, none of these conditions exists in the U.S. What's more, choice has yet to produce outstanding health status or equitable access to needed care, especially when compared with the health systems of other industrialized nations, she says.

"Ultimately, choice comes at a price. As consumers, we are expected to pay for the privilege of choice, and if we cannot pay, we do not get to choose and, more than likely, do not get at all," writes Edwards. "I left the U.S. convinced that having less choice in health care is a price well worth paying for universal coverage."

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