Choice equals competition equals market-based solutions to healthcare.
Market-based solutions to healthcare don't work. Why? Because market actors by nature define and limit/avoid/pass on risks.
Any viable healthcare solution has to figure how to absorb those risks. The whole point of healthcare is to treat people who are sick. Sick people are the risk in a health situation. Limiting the cost of treating sick people is the insurers' interest. A health system must embrace the problem, not limit/avoid/pass it on. It's the opposite kind of problem.
There are, of course, many sorts of businesses for which the market works well. But healthcare ain't one of them. You don't have to be a socialist to see that healthcare isn't the sort of problem capitalism solves. At best, capitalism contributes to a solution. But to get market actors to absorb risks, you have to devise a system that builds compulsion and regulation in in some form. This includes making folks who perceive themselves as being low risk or who wish not to pay for insurance to participate in the market.
Political ideology demands that some things that are obvious cannot be so, because otherwise the ideology fails. If you know that markets are always the best answer, you are always going to find it impossible to understand the market's limits. You won't understand the profound importance of things like negative externalities. You wont see the value of regulations operating in a different layer from competition because principles like integrity and trust are necessary to the efficient running of the market. Indeed, you won't understand that the intrinsic nature of property rights involve a form of restriction imposed on everyone but the owner of the asset: weapon-enforced rights are dangerous and liable to the promotion of injustice: and worse, they are inefficient.
If you cannot admit these limits, you are doomed to create poor economic structures, such as dumb health models which seek to turn sick person units into money-making opportunities or that provide inadequate coverage. Or both. Which is what we get with Paul Ryan.
Choice: yippee!
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