His basic point is an important one that bears repeating: America does not currently have a free-market medical system. In particular, he notes
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...
The thing to remember in America is that we have single-payer health care for the elderly and for the poor: the two costliest groups. In addition, the relatively healthy middle class has heavily-subsidized private health insurance, in which few individuals have the freedom to choose the insurance plan they receive. Neither of these facts commend the American health-care system to devotees of the free market.
Avik Roy does praise statist elements in some other countries' health systems, such as Switzerland and Singapore -- which I disagree with. But those are topics for a separate day.