????我們老是會聽到這樣的說法，市場力量能在汽車、手機和住房等領域為大眾帶來價格實惠的產品，但在醫療保健領域卻從來都不管用。

????據說造成這個謎團的首要原因是每個病人的情況都千差萬別，每個療程也都必須辯證施治，所以醫生沒法提前決定治療成本，也沒辦法告訴病人治療費用。所以，向病人提供他們可以比較的價格完全行不通。另一個原因是，藥物太復雜了，病人沒有能力選擇費用低、療效好的方案。第三個原因則是有這么個觀點——這跟其他經濟領域形成了鮮明對比——即新技術會不可避免地使醫療費用更加昂貴。

????這些常常掛在人們嘴邊的說法沒有根據。最能說明問題的就是競爭白熱化的整容手術和微創治療技術。

????而一份出自保守派智庫“全美政策分析中心”（National Center for Policy Analysis）的最新研究報告表明，醫療保健行業的發展動力其實和其他領域通行的模式無異。這篇報告的作者是經濟學家德文?赫瑞克，他在收集并分析了“美國整容外科協會”（American Society of Plastic Surgeons）的年度統計調查數據后，發現了一些非同尋常的趨勢。

????過去二十年間，美國的醫療價格——并不是總花費——每年的漲幅約為5%，也就是“居民消費價格指數”（CPI）的兩倍。相比之下，整容手術的價格每年僅微漲1.3%，也就是比通脹比率整整低了1.2個百分點。

????之所以會出現這種現象是因為，整容手術要靠病人自己掏錢，這樣一來他們就和其他消費者的行為沒什么區別了。他們會貨比三家，選擇性價比最高的方案，同時樂在其中。而在其他醫療領域，醫療成本主要是由第三方、雇主、保險公司或聯邦醫保和醫療補助計劃埋單的。患者每花一美元治療費，自己只需出11%。因此他們幾乎不會有任何動力去尋求最優惠價格。

????這與整容手術的情況恰恰相反：在面部整容或肉毒桿菌注射中省下的錢恰恰是可以花在度假或孩子學費上的。這類醫生也會大打折扣來拉生意。像Groupon和LivingSocial這類團購網站經常會推出“每日特惠”的整容手術。赫瑞克發現，肉毒桿菌注射的平均花費已從2007年的500美元降到現在的365美元。

????而美容手術的增長幅度也確實比其他醫療保健項目要大得多。面部整容和抽脂術這類整容手術的總量以年均8%的速度在增長，而像褪毛和蜘蛛靜脈激光切除等微創手術 的年均增幅更是高達28%。

????但是，這樣的大幅增長并沒有帶來價格的猛漲。由于競爭激烈，醫生必須定價合理。絕大多數這類整容手術都在診所開展，價格要遠低于醫院手術室。這方面從業者和相關機構的供給彈性很大——它很好地說明了為什么應該讓醫療領域的勞動力像其他領域一樣根據市場供需規律來自由流動。

????We're constantly hearing why the market forces that bring us great deals on cars, cellular phones, and houses can never work in health care.

????One leading myth is that each patient is so different, and every procedure so tailored, that doctors can't determine the cost, or tell patients the price, in advance. Hence, providing consumers with prices they can compare is totally impractical. Another holds that medicine is so sophisticated that consumers are incapable of choosing deals that combine low cost with the promise of excellent outcomes. A third is the concept that -- in contrast to every other area of the economy -- new technology inevitably makes everything more expensive.

????Those oft-repeated beliefs are wrong. And the best evidence is the ultra-competitive field of cosmetic surgery and minimally invasive treatments.

????A new paper from conservative think tank the National Center for Policy Analysis, shows just how the industry's dynamics follow the patterns that prevail everywhere else. The author, economist Devon Herrick, collected and analyzed data from the annual statistical surveys of the American Society of Plastic Surgeons, and the trends he has identified are extraordinary.

????Over the past two decades, U.S. medical prices –– not total spending –– have been rising at around 5% per year, or twice the increase in the CPI. By contrast, prices for cosmetic surgery are inching forward at just 1.3% a year, or a full 1.2 percentage points lower than inflation.

????The reason is that patients spend their own money on cosmetic treatments, and in doing so behave just like consumers everywhere else. They shop for the best deals and love doing it. In every other medical field, costs are largely covered by third parties, employers, insurers, or Medicare and Medicaid. Consumers pay just 11 cents for every dollar in care they consume. The rewards for seeking the most favorable prices are nil.

????It's just the opposite in cosmetic surgery: Whatever you can save on a facelift or Botox treatment is money you get to spend on a vacation or your kid's tuition. Doctors compete vigorously to win business using steep discounts. Websites such as Groupon (GRPN) and LivingSocial regularly offer "deals-of-the day" for cosmetic procedures. The average cost of Botox, Herrick found, dropped from $500 in 2007 to $365.

????The growth in cosmetic procedures outstrips virtually every other area of health care. The volume of surgical procedures, such as facelifts and liposuction, is rising at 8% a year, while minimally invasive treatments like hair and spider vein removal with lasers are increasing 28% annually.

????Yet the explosive demand has not been accompanied by big prices. The keen competition forces doctors to prize efficiency. Most of the procedures are conducted in clinics where costs are far lower than in hospital surgery rooms. The supply of practitioners and facilities is highly elastic -- a great argument for why allowing manpower to freely follow the market works in medicine just as everywhere else.