None of those things characterize our current health care system, even under the ACA.

Most consumers have no idea what health care costs beyond the occasional bottle of pain reliever, not just because their insurance coverage insulates them (for those with insurance, that insulation is quite real), but because those costs are often nowhere to be found until the bill arrives from the surgeon or hospital. Most members of the general public have no knowledge of medicine, and thus no knowledge of what their physician is telling them beyond “Is it serious?”

Regulation of the health care industry is a pleasant fantasy, and I admit I engage in it occasionally, but it is merely that – a fantasy. Not many physicians are interested in seeing their incomes regulated, nor are the manufacturers of health care-related devices, from heart valves to crutches, to orthopedic shoes. Any serious suggestion of regulating devices, prices for procedures, room occupancy costs for in-patient hospital stays, etc., is routinely met with howls of outrage, predictions of the apocalypse, and stories of grandmothers dying at the side of the road because their medical provider went out of business due to the crushing burden of regulation, which typically would involve, for example, publicizing their prices BEFORE procedures were performed or hospital rooms booked.

And finally, of course, largely because of our ad hoc insurance system, and the insulation it provides to patients, most people have no idea what, for example, an office visit, treatment of a sprained ankle, or repair of a broken bone from a ski accident, actually costs. Nearly 40 years ago, I was being charged more than $5 for a single aspirin in what was supposedly a “nonprofit” hospital. Things have only gotten worse since then.

The “market” Mr. Miller describes for health care is as much a fantasy as any expert’s vision of reforming our current system so that affordable health care is available to everyone. What Mr. Miller proposes is health care for those who can afford it, illness and death for those who cannot. Those are interesting values he’s putting on display.