Editor's note: This is the first of a five-part series.

None of the virtues of the free-market system can effect the goal of improving access, quality and value of the U.S. health-care system because medical care is not a commodity and patients aren't consumers, says a local physician and a longtime health-care reform advocate.

Reform cannot possibly ever fit the free-market model because "no matter how you parse it, people seek out medical care by necessity, not by choice," Dr. Joe Jarvis told the Deseret News.

It's not a free-market model now, it's inefficient at best, and to call it that or say it can be a commodity market "is the height of intellectual dishonesty," he said. There is no relationship between price and demand. "No matter what anyone says, no one has ever had an appendectomy because it was on sale."

The free market isn't a free market anyway, he added.

About $1.5 trillion — 60 percent of the $2.5 trillion medical economy that is a sixth of the entire national economy — is tax funded. That pays for Medicaid, Medicare, Veterans Administration, Indian Health Services, public employees' health benefits, military care, tax credits for employers buying health-care benefits and so on.

That on its face shows that we treat health care like infrastructure — building and maintaining roads — not like it's a commodity on the shelves people go shopping for, he said.

In addition, if medical care were a commodity, providers wouldn't be paid for repeat scanning and treatment, hospitals wouldn't make more money when people get sicker, and "we wouldn't be paying more money for more care, which in effect rewards mediocre care," Jarvis said.

"In effect, the system pays doctors to harm patients," he said. "Main Street commerce and markets do not have these kinds of perverse financial incentives."

He said members of the Utah Legislature's Health Care Reform Task Force and all four reform proposals vying for congressional endorsement say no one can judge how well a market will work in health care on past performance because we have never had the conditions right for a trial of market forces.

"The various 'conditions' that make testing market forces impossible — employment-based health benefits, taxpayer-paid health benefits — are in fact caused by lack of fit between health care and the market model, not the other way around," he said.