Maybe our system needs decline

Re "Subsidizing insurance props up dysfunction. There's a better path," Opinion Voices, Nov. 20

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ANDREW HARNIK Getty Images THE EXPIRING Affordable Care Act subsidies remain an unresolved issue.

GUEST contributor Kim-Lien Nguyen dusts off a tired and roundly disproven libertarian solution to our healthcare financing crisis, arguing that giving consumers money directly instead of to private insurers will somehow magically "empower" them to "make their own healthcare choices and leverage their self-interest.

This assumes that healthcare operates as an ideal free market and consumers and patients are all-knowing about the product they are purchasing when, in fact, the opposite is true.

Does a patient with chest pain that could be a heart attack really have time to study and decide on which ambulance service and emergency room they would like to go to from a cost standpoint? The same can be said for every major medical problem. And the amount of money that would be given directly to consumers will never cover the costs of care.

What is needed is what every other high-income country is doing, which is yielding better outcomes and lower costs than the U.S.: a universal unified system of public insurance, perhaps “Medicare for all.”

Nguyen also argues that “we don’t have to settle for a managed decline of our healthcare system.” But that is exactly what is needed for our financing of the system in order to ease the transition to a public nonprofit insurance system, very similar to a “managed decline” of our dependence on fossil fuels.

STEVE TARZYNSKI Santa Monica

This writer is the former president of the nonprofit advocacy group California Physicians Alliance.

The author suggests that giving the money directly to individuals would allow them to buy their own health insurance plan or pay for healthcare directly. The problem is, how much insurance can $2,000 (or however much is allotted) buy?