The Free Market Utopia, in deceptive arguments

Today on Megan McArdle’s blog there’s an argument from Avik Roy as to why the U.S. isn’t really a free market health care system. It uses the familiar arguments but takes it too far, in an entirely deceptive direction:

In reality, per-capita state-sponsored health expenditures in the United States are the third-highest in the world, only below Norway and Luxembourg. And this is before our new health law kicks in.
…
In 2009, according to these statistics, which come mostly from the OECD, U.S. government entities spent $3,795 per person on health care, compared to $3,100 per person in France. Note that these stats are for government expenditures; they exclude private-sector health spending.

Of course, he carefully omits the private health care expenditures, which are surely number one in the world. Since it probably sacrifices too much rhetorical power to describe the U.S. as simultaneously the world’s biggest free market health care system and its third-biggest government-run health care system, it’s probably most fair to describe the U.S.’s health care system as a bloated chimera. (Roy also points out the tax expenditure that subsidizes private insurance, but of course all economic transactions are at a certain level government-subsidized. The tax expenditure subsidizing private insurance isn’t a bad idea because it’s a cobblestone in the road to socialism, it’s because it encourages over-consumption of health care.)

Roy feels that health care would be better off in a free market state (“…health-care spending is most efficient when that spending is executed by individual patients, rather than third parties”), so you’d imagine he’d be cheered by the growth of HSA accounts. Of course the theory of price discipline on the individual producing efficiency sounds wonderful, but the practice is considerably different—individuals subjected to price discipline tend to cut out preventative care, and of course it enshrines fee-for-service as a central feature of the health care economy.