> To be a bit glib there is no competitive market to give me an emergency surgery if my appendix has burst.

This is what everybody resorts to when trying to claim that this can't work, but it's really more an excuse to not even try.

The large majority of medical spending isn't emergency care. You can't shop around for an appendectomy doesn't mean you can't shop around for a joint replacement.

> I just think “free” isn’t a useful distinction because it’s approached usually a shorthand for free of regulation. I think that all markets are artificial and require rules to form a functional marketplace of exchange.

There are a couple of different dimensions along which you can measure this. One is the type of regulation that exists.

Markets need externalities to be priced, otherwise companies will dump industrial waste in the river. That's one type of regulation.

Another is paternalism. You can't buy a huge soda because it will make you fat. That's not an externality. You're the one choosing to buy and drink the soda and you're the one who gets fat. You're the one who buys the poorly insulated house and you're the one who pays the heating bill. This isn't Alice doing something that hurts Bob, it's Alice doing something that hurts Alice. It's a different type of thing, and we could do without it entirely and still prohibit companies from polluting the rivers.

Likewise, some regulations are, shall we say, petty. Some might say illiberal. You can't put an addition on your house or finish your basement because then more people might live in it. You can hypothetically frame this as an externality, because then there might be more traffic or something, but the underlying premise would have to be that this is something other people have a legitimate right to prevent and that interest should override another person's interest in having somewhere to live. We could do entirely without this type of regulation too.

The other dimension is that regulations of actual externalities can be unnecessarily burdensome. You can pass a law against dumping mercury in the river and then fine anyone caught dumping mercury in the river. Or you can pass a law against manufacturing products without testing each and every one of them for the presence of mercury, even if you don't use any mercury in your manufacturing process, and then fine anyone who doesn't pay for testing, coincidentally by a testing company owned by a legislator's brother which employs a lot of people whose unions made some generous campaign contributions. Or just establish administrative agencies with too many bureaucrats who run out of anything legitimate to do and start to micromanage everything.

Regulating externalities efficiently is a hard problem and claiming that you can't have a free market unless you can remove externalities without any inefficiency is basically claiming that you can't have a free market. We could certainly do better than we do right now, and there is value in the attempt, but it's never going to be perfect.

Whereas the rules that are purely paternalism and politics? If the claim is that a market with those kinds of rules isn't a free market, that's a fairly legitimate claim.