People on the left tend to think that the system we have now is proof that the right’s approach doesn’t work, since it’s a private health-care market and costs are out of control. But we actually don’t have a consumer-driven market in health insurance today; what we have is more like a government-dominated market. A consumer-driven market would be one in which consumers make spending decisions and so producers have an incentive to give them what they want at a competitive price. But our system today is dominated by three government programs or policies that prevent the emergence of such consumer pressure: Medicare, Medicaid, and the tax exclusion for employer-provided insurance. Each of these means that consumers do not make direct purchasing decisions, and each of them contains an enormous incentive to spend more, and therefore pushes costs up.