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Competition is important for health-care insurance, but loosening regulations won't achieve it

blackburnfiling.JPG

Among the main Republican talking points today is that the health-care system needs more competition, and the way to get that competition is to let insurers sell across state lines. Rep. Marcia Blackburn hit this particularly hard: The way to bring down costs, she argued, is to let consumers do the regulation, which means letting them pick insurance sold in other states.

This is nonsense. Selling insurance across state lines doesn't increase competition between insurers, it decreases standards. I live in Washington, D.C. I can choose among many insurers right now. But it's hard to do because the insurance market is poorly organized, and because my employer doesn't give me many choices, and because choosing a different insurer and all new doctors is a pain in the neck. That's why there's fairly little competition in the system.

What I can't do is choose an insurer who abides by Delaware's regulations rather than D.C.'s. Lift that rule and what you have isn't competition driven by consumers, but a regulatory competition to have the laxest regulations so you have the most insurance jobs in your state. It's exactly what happened in the credit card market, and it's why a bipartisan majority voted to impose new federal regulations on credit card companies last year.

Competition only flourishes in an environment of effective information. When you make the regulation less dependable, you make the product less dependable, which means you remove necessary information from the system and make it harder for individuals to figure out how to make good decisions. If I hear a lot of horror stories about people buying insurance that unexpectedly abandons them when they get sick, I'll be less likely to try and change mine if I'm dissatisfied with it, as I can't be confident that my next carrier will treat me better.

The major step forward for competition is the exchanges, which have regulators making sure the insurance is good enough to deserve the name; which allow consumers to rate the plans; which force the plans to offer standardized information so they easy to compare; which provide a large numbers of plans to choose from; which makes it easier to shop for your insurance in one place; and so on. Yet Blackburn didn't make mention of them. Competition is a good idea. But there's precious little Republican enthusiasm for the policies that would actually promote it.

For more on selling insurance across state lines, see this post. For more on exchanges, see this column.

Photo credit: Lucian Perkins/The Washington Post.

By Ezra Klein  |  February 25, 2010; 4:00 PM ET
Categories:  Health Reform  
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Next: The best health care for the most powerful people in the world

Comments

Ezra is a misguided liberal hack. He was shaken too much as a baby. Now he's all confused. Tisk, tisk.

Posted by: surfcityred | February 25, 2010 4:12 PM | Report abuse

Competition is vital; in 34 states, 75 percent of the insurance market is controlled by five or fewer companies. In Alabama, almost 90 percent is controlled by just one company.

What to do about it?

I'd say the first step is taking away the insurance industries anti-trust exemption. That passed the house by a wide margin, but will most likely be fillibustered to death in the Senate.

The second step, in my opinion, is the exchanges. I think federal regualtions would be more effective, but the Senate would fillibuster that as well.

Sadly, even once the exchanges go up (should the bill pass) the vast majority of Americans STILL won't be able to choose their own policy because most people get their insurance through work and therefore have no say in it.

Posted by: nisleib | February 25, 2010 4:17 PM | Report abuse

Ezra - selling insurance across state lines will not be a cure-all for the insurance market. But your post is somewhat misleading. The point of inter-state competition is just as much about lowering prices as it is about increasing the number of insurance options. Some individual markets are so over-regulated and over-burdended with mandates that it's impossible to purchase a reasonably priced product.

Allowing inter-state sales would allow consumers in some of these markets to purchase cheaper coverage. That's a fact and it's not even controversial. You need only look at individual insurance prices in Florida vs New York to see that this is true (FL costs are only half of NY costs). Are people in Florida getting "screwed"? Or are people in new York being priced out of the market because the state requires so many services to be included in every policy?

We can have a debate about whether it will be overly confusing for consumers or whether some people might make poor decisions. But to claim the loosening SOME regulations won't help SOME people is dishonest.

Posted by: mbp3 | February 25, 2010 4:17 PM | Report abuse

In the Republican version of "unmanaged competition," what happens when there is a consumer-protection problem - do you appeal to the federal government, your state government, or the state where the insurance plan is located? And doesn't Republican cost control really amount to pricing people out of the system? If so, isn't that rationing, and shouldn't they be upfront about it?

Posted by: jduptonma | February 25, 2010 4:18 PM | Report abuse

The exchanges sound like a good idea. I'm not a professional healthcare wonk, so I'm not sure. But they sound like a good idea. They seem to accomplish the competition Republicans are looking for. Why are Democrats having such a difficult time pointing that out?

"But there's precious little Republican enthusiasm for the policies that would actually promote it [competition]."

There's plenty of enthusiasm for policies that would promote competition when the Democrats won't be able to take credit for any of it. As long as the Democrats can take credit for something, the Republicans aren't going to be enthusiastic.

On the Republican side, this is and will remain about winning back seats in November. And compromising with Democrats is, quite frankly, not the way to do that.

If things looked bad for the Republicans--if their recent hard-line tactics had resulted in losses in Virginia, New Jersey, and Massachusetts--they wouldn't be doing this. But they have no reason to think that they will be punished--nay, they may well be rewarded--for their obstructionism.

That being said, Scott Brown rocks. Comes out of the box, voting like an independent representative of his constituency. And here I was thinking he was going to start his senate career by burning down our national forests and drinking the blood of poor, uninsured children.

Whoops. I mean to say, that being said, the health insurance and credit card markets are different animals. This means the competition for the most lax standards would not be the same, at all, and that it would have to be treated differently then letting credit cards market banking services across state lines.

And the "across state lines" thing isn't always about regional standards, either. Ask anyone who has a bank account in another state for personal or practical reasons. There are people who bank in states other than the one they live in and Delaware.

That seems even more true with health insurance, as if you self-insure, and like your Blue Cross/Blue Shield Tennessee, there's no reason why you shouldn't be able to keep it when you move to Florida. It's not all about competition.

Posted by: Kevin_Willis | February 25, 2010 4:25 PM | Report abuse

Doesn't the Senate bill give the option for states to enter compacts that allow selling across their respective state lines?

Posted by: msh31 | February 25, 2010 4:28 PM | Report abuse

Poor Klein. The current disarray of the insurance companies, and the current horrid structure of the credit card companies, are simply the distorted outcomes of all the previous meddling in those areas by the federal government. And you can't fix them by poking and prodding them some more.

The problem is government, and those crooks are not going to loosen their grips on things without being forced to.

Posted by: msoja | February 25, 2010 4:30 PM | Report abuse

Ezra, this is a pretty poor argument on your part. You can have competition either with or without cross-state insurance. The difference is the range of available insurance types (i.e. meaningful competition) with the different approaches.

Currently, each state sets its own rules.

If New York, for example, wants to take the nanny-state approach, and impose very aggressive "minimum standards", then New York has greatly limited the realm of competing types of insurance. A new competitor (or an existing one), can't enter the market with a low cost / low benefit plan contrary to those standards.

Texas might do the opposite, and have no minimum standards. The range of allowable insurance options is greater in Texas.

You probably fear that, in such a scenario: (a) all insurance companies will be formed in Texas (quite possibly true); and (b) all insurance companies in Texas will only offer low-benefit insurance. That is false. High benefit plans can be, and are, offered in such states.

What you really fear, is that, given the choice, people will choose the cheap insurance, and then not be happy when its benefits are limited. That could be because (1) disclosures are poor (I have no problem with regulations on that point); or (2) people are, in your opinion, too stupid to make good choices (classic liberal nanny-state view).

This issue is a classic conservative/liberal one. Do you restrict choice for all because you worry that some people can't "handle" such responsibility? Or do you allow some people to make poor choices (for them), but treat everyone like adults?


Posted by: WEW72 | February 25, 2010 4:50 PM | Report abuse

--"treat everyone like adults?"--

Heh. Klein is so sure of his own intellectual superiority that that is never an option. The stupid little people need government policy to guide them, and he's going to do everything he can to make sure they get it.

Posted by: msoja | February 25, 2010 4:54 PM | Report abuse

mbp3,

Your post itself is also misleading. Here in Massachusetts, we have a 2:1 age rating, no smoker rating, and items such as maternity care are required to be covered. As a 30-year-old Bay State bachelor, I'm required under the individual mandate to buy maternity care, alcoholism treatment, general mental health, mental health parity, and well-child care (http://www.cahi.org/cahi_contents/resources/pdf/HealthInsuranceMandates2008.pdf) and everything at a minimum 56 percent actuarial value. In Mike Enzi's Wyoming, there are no underwriting limits in the individual insurance market, and insurance policy is not required to cover maternity care, alcoholism treatment, general mental health, mental health parity, and well-child care. So being a young, healthy bachelor, I could save ton of money by purchasing health insurance in Wyoming without the 2:1 community rating and the mandated benefits and minimum actuarial value if federal laws allowed. So could many other bachelors my age and younger.

Meanwhile, those who my premiums and other young bachelors' premiums subsidize from the Bay State's 2:1 community rating and mandated benefits would be left in a risk pool that is much, much older and sicker. This would make premiums on the Massachusetts Exchange skyrocket, and health insurance would be unaffordable to those very people who the community rating and minimum benefits package were designed to protect.

In other words, allowing insurers to sell across state lines amounts to taking several hundred thousand dollars out of a cancer patient's pockets, and putting it into a bunch of 25-year-old bachelors' pockets and a few insurance company executives.

Posted by: moronjim | February 25, 2010 4:55 PM | Report abuse

And, of course, Klein's inflated sense of his alleged intellectual superiority is only completed by the sureness of his moral superiority. He has all the components necessary to your average statist goon.

Posted by: msoja | February 25, 2010 4:58 PM | Report abuse

WEW72,

"classic liberal nanny-state view." Call it what you want, but we liberals believe our government should rise to the level where it corrects the gaps that exist by chance or by wisdom we don't fully understand.

Buying insurance is not like buying a widget. No grocery store has a problem selling a loaf of bread to a homeless person. No electronics store has a problem selling a stereo system to a teenager. But no insurance company is going to take a cancer patient, a family with a diabetic child, or a pregnant woman. These people can want insurance all they want, but they cannot get insurance because of factors beyond their control. Should we punish these people because of their circumstances?

Posted by: moronjim | February 25, 2010 5:03 PM | Report abuse

WEW72 - I get what you are saying, but most people have no say whatsoever in what kind of insurance they have. Most people get their insurance through their jobs. Therefore it isn't really a matter of personal responsibity. The arguement can be made that people pick their insurance when they decide to take a job, but in this labor market that could get you laughed at.

But let us put that aside and look at similar situations. As Ezra has pointed out many times the credit card companies, until recently, had the same kind of interstate commerce coupled with state regulation and it was a disaster.

I think Ezra is correct on this one. Loosening regulations and allowing health insurance companies to relocate to the states that have the most lax regulation would cause a race to the bottom. It may help insurance companies bottom lines, but it would hurt Americans.

I do like the state based exchange idea. It allows insurance companies to sell their products in various states, as long as the insurance sold meets certain requirements.

Posted by: nisleib | February 25, 2010 5:04 PM | Report abuse

moronjim

Your point is all about pre-existing conditions. That is not related to cross-state insurance at all. All states allow insurance to discriminate based on pre-existing conditions. Without that factor, premiems would skyrocket.

The current proposal would address that issue by coupling a mandate with a ban on such discrimination. That has its own issues, but its seperate.

Posted by: WEW72 | February 25, 2010 5:32 PM | Report abuse

Decoupling employment from insurance should be STEP NUMERO UNO!!!

Do that quickly in one simple bill!!!

Give that tax exclusion to every single American!!!

And we can move on from there----dishonest agendas by BOTH PARTIES have cause our healthcare system to become MORE AND MORE dysfunctional everywhere!!

The remedy is to bring this back to reality----so real world checks and balances kick in. Stop the insanity of comprehensive healthcare where consumers are shielded from the reality of how much their service actually cost....everytime they use a medical service, they should pay for its value(or some at least function of it).

If at all possible, lets move control of the details to the state level---let statehouses workout how they micromanage it---and keep federal bureacrat's paws off of MY HEALTHCARE! If my statehouse doesn't meet my needs, I at least have an option to relocate out of the state!

Posted by: FastEddieO007 | February 25, 2010 5:36 PM | Report abuse

nisleib,

If you look at Ezra's back and forth with Ryan, they are arguing that point. I'm all for exchanges, and decoupling insurance from employment (I know its not realistic, but oh well). I think Ryan would agree to a "minimum" level of benefits on the exchange. But Ezra's idea of "minimum" and Ryan's idea of "minimum" are very different.

Posted by: WEW72 | February 25, 2010 5:37 PM | Report abuse

Democrats will be irresponsible Americans if their zeal to give poorer Americans access to healthcare services causes them to overlook the REAL CRISIS in spiraling costs!

Without fixing spiraling costs, any attempt to create a system that gives access to the poor will have the unintended consequence of worsening the healthcare services provided to all Americans! If/when that happens, the Democrats as we now know them will be eliminated as a party in national politics!

Posted by: FastEddieO007 | February 25, 2010 5:43 PM | Report abuse

@mbp3

Yes, the people in Florida are often getting screwed. Just ask all the people who get seriously ill and then discover that all the loopholes and restrictions in their policy prevent them from getting any assistance from their coverage. This is to say all of the people who are being forbidden from freely buying a product due to an existing illness.

The fact of the matter is that policies in Florida are cheaper because less illnesses are being covered and a higher proportion of people are falling into medical bankruptcy. This is the fundamental deception of the new Republican proposal (as opposed to the old Republican proposal that Obama is now trying to pass). It's like proposing that we pass a law that allowed insurers to arbitrarily deny any claim they pleased. This might help cut premiums by an incredible amount but it would render insurance nearly useless... as it often is in underregulated states like Florida.

In regards to Canada, I don't see why it matters that someone came here for treatment. There are plenty of Americans who go to Europe to be treated by certain specialists. I know someone who went to receive neurosurgery in Belgium. Does this automatically mean Belgium has a better health care system than the U.S.?

Posted by: eleander | February 25, 2010 5:45 PM | Report abuse

This notion that extending coverage will hurt the quality of care is just another GOP meme that its faithful bots jabber without a single scrap of understanding about health care economics.

While it's true that extending insurance coverage to all might increase premiums in the individual market for a variety of money, it will not reduce the quality of care. After all, as your the other more accurate and completely contradictory GOP talking point states, extending coverage won't reduce the costs of services.

The end result is that providers will see a massive influx of revenue that will go towards hiring more medical professionals and building more medical infrastructure.

On top of that, there will still be doctors who choose to primarily deal with the wealthy who pay either with gold-plated plans or pay out of pocket.

The GOP bots like FastEddie need to decide if they're going to attack the plan on the table for its genuine faults or the idea of single-payer. You can't attack this plan as both. At least, you can't do it without looking like an uninformed buffoon who can't recognize that his own argument is laden with contradictions.

Posted by: eleander | February 25, 2010 5:54 PM | Report abuse

This is all about Left-wing Authoritarianism.

Authoritarians like Ezra hate the idea of *consumers* being able to choose whqat health plans they want. Ezra and other authoritarians think that consumers are too stupid to know what's best for themselves, so they need nanny-state regulators on an exchange telling them what kind of insurance they can buy.

If Ezra stepped away from the Obama talking points for a moment and thought about it, there is absolutely no contradiction between inter-state competition and the insurance exchanges. We could easily have *both* - that is, if an insurer from Delaware wanted to cover a consumer in Maryland, the Delaware insurer would have to sell through the Maryland exchange but would otherwise comply with Delaware rules. And the Maryland consumer could simply look at his exchange and choose one of the Maryland insurer plans listed on the exchange or a plan from the Delaware insurer also listed on the same exchange.

But, again, Ezra and other Left-wing authoritarians *hate* the idea of giving consumers these types of choices.

Posted by: asudnik | February 25, 2010 6:05 PM | Report abuse

@WEW72: I assume since you're all about letting people make informed decisions, then you're in favor of the Medicare buy-in or public option in the House health care bill. Those who like the government option can buy into it and those that don't can stick with the private market. If you're all about competition and choice, this policy clearly fits.

The problem is bigger than "responsibility" or "choices." You don't "choose" to get sick, nor can you predict when you will get sick (although you can choose to lower your risk factors, there's still a lot out of your control). So who pays for that person in Texas with the worthless insurance when he or she does get sick and needs to go to the ER?

I'd bet people will often pick the lower priced option without fully understanding what they're getting (insurance is complicated product). Ensuring the general population has a minimum standard takes some of this confusion away. What both bills do is lay out a basic minimum plan (and when I say basic, I mean SUPER basic - 60% actuarial value). Even the Repub bills do this.

Offering a plan less than that is basically useless aside from catastrophic incidents, and even in that case they may not cover everything.

And to add a point that most people haven't mentioned, doctors have a much easier time when they don't have to worry about what specific procedures are covered and can focus on the medicine - that is their job. Too often patients are given sub-par options because they don't have coverage - I am a medical student and have seen this first hand, and it's quite frustrating.

Posted by: kmani1 | February 25, 2010 6:14 PM | Report abuse

To all the people on here who cant seem to and dont want to understand simple cause and effect. lets try a thought experiment, you are the ceo of a large health insurance, you are able to sell insurance to anyone in the us who wants it but the state you live in has really strict standards of what you can offer that loses your company money. should you keep your job if another state has lax regulations and would help your company make even more money and you didnt move headquarters there? now lets say your the mayor or governor of a state with double digit unemployment, you want to keep your job so what can you do? you notice that insurance companies want to move to your state but your state regulations are way too strict. do you really think you wont cut a deal with those insurance companies to bring them all to your state and increase employment?

Simple cause and effect, did you people actually go to school or are you being dense on purpose.

Posted by: edgepark12 | February 25, 2010 6:18 PM | Report abuse

--"Should we punish these people because of their circumstances?"--

Hmm. Going on about one's own life is punishment to those who can't or won't exhibit the same diligence? There's a little nuttiness in there somewhere, isn't there?

The majority of people work hard enough just taking care of their own. Why do busybody bleeding hearts insist on punishing them in the name of forced charity?

And the whole thing is a crock, anyway, since this stupid Socialism drags *everyone* down, including those for whom one's heart ostensibly bleeds so profusely.

Posted by: msoja | February 25, 2010 6:23 PM | Report abuse

"Competition only flourishes in an environment of effective information."

Beyond effective information, I would add that competition only flourishes when people have high standards. And the more people need something, the lower their standards for it go. Hence the state of our current system. Already I think people's standards are too low for nonessential items. Our standards for essential items are even lower. For living in a deeply capitalist society, we're all a bunch of really bad consumers.

Posted by: slag | February 25, 2010 6:23 PM | Report abuse

kmani1

Nope. Medicare/Medicade is currently being subsidized by private insurance. M&M pay too little, and private insurance pays too much. M&M are too big, and have too much buying power, so they can dictate their rates. Everyone else pays the price. If M&M get bigger, it puts more pressure on private insurance, whose rates rise even higher, pushing more people to M&M, ....

Its the exact same issue as with the "strong" version of the public option (i.e. public option using M&M or near M&M rates).

Private insurance cannot compete with public insurance in such a system. Its why most progressive's like the public option (its a back door play for single payer).

Posted by: WEW72 | February 25, 2010 6:24 PM | Report abuse

"Why do busybody bleeding hearts insist on punishing them in the name of forced charity?"

Maybe you missed the part in which Obama explained that we're already paying for uninsured individuals and that we just don't see it. The purpose of the mandate is to get those freeloaders off our premiums.

Posted by: slag | February 25, 2010 6:25 PM | Report abuse

--"did you people actually go to school or are you being dense on purpose."--

Apparently, they didn't teach YOU about punctuation or capitalization in school, but that's no matter. Your point is decipherable, and here's the answer:

In a free market (hell, in a free country), you're not compelled to buy an insurance policy (or any policy at all) that doesn't comport with your own values. Of course, no one is obligated to create the product you think you want (I want a five dollar Mercedes!), but if there are enough people wanting the same thing, and it's reasonable, sooner or later someone will be along to fill the niche.

As it is now, your choices are very limited, and very expensive, and it's mostly because of all the government fiddling with what ought to be private contracts between consenting adults.

The fact is, if government could somehow be completely extracted from the health care business, many taxes could be lowered or eliminated, insurance products would proliferate, prices would come down, and health care prices in general would come down. The whole thing is in crisis because of the perverse incentives jiggered into the system over the last seven or so decades. Every iteration of government meddling makes it worse and worse.

Frankly, I think complete collapse is the only way out, now. Politicians certainly aren't going to figure it out. And the country is too dumbéd down to even help 'em.

Thanks for asking.

Posted by: msoja | February 25, 2010 6:35 PM | Report abuse

--"The purpose of the mandate is to get those freeloaders off our premiums."--

But you're still paying for them, plus, you're encouraging them, so you're going to wind up paying for even more of them. It's nonsense. It makes the so-called crisis worse, and burdens everyone more.

Posted by: msoja | February 25, 2010 6:38 PM | Report abuse

ps. Anyone here every hear of such a thing as evolution? It's a big theory. Or has anyone ever watched one o' them there nature shows. Same thing, really.

Everyone dies, you know. And humans are special, I know. But the human herd is not immune to forces and realities of trying to survive on a spinning rock in the vastness of empty space.

Evolution works best when individuals are free to seek their own survival. Those with sufficient resources might feel inclined to volunteer some of those resources to enhance the survival of those they favor. Or they may not. It's a matter of one's particular abilities and predilections. The gene pool is improved one individual at a time. Those surviving most, survive best, and the herd improves.

But this ongoing nonsense of coercion and force is not really the best thing for the herd. For one thing, people chafe under the yoke, and rightly so. It's not human nature to live as a collective, like ants.

Klein's ant wannabes should get a little real, somewhere, and quit trying to ruin the herd out of ignorant short mindedness.

Posted by: msoja | February 25, 2010 7:07 PM | Report abuse

"But you're still paying for them, plus, you're encouraging them, so you're going to wind up paying for even more of them. It's nonsense. It makes the so-called crisis worse, and burdens everyone more."

This is funny. We're paying for them in the most inefficient way possible--through ER visits. And subsidizing the premiums of the poorest of them isn't going to burden anyone more. It's going to alleviate the system of a useless inefficiency. And it's not just me saying this. The CBO says this. Your not liking their assessment doesn't make it wrong.

Posted by: slag | February 25, 2010 7:10 PM | Report abuse

"ps. Anyone here every hear of such a thing as evolution? It's a big theory. Or has anyone ever watched one o' them there nature shows. Same thing, really."

I'm curious. Do you ever look in the mirror and wonder whether even you believe some of the things you say?

Posted by: slag | February 25, 2010 7:12 PM | Report abuse

--"The CBO says this."--

LOL. Like the pols said it in Massachusetts, right?

//begin cite:
Responding to an op-ed by Massachusetts governor Deval Patrick calling his state’s plan a “Health-Reform Model,” the president-elect of the American College of Emergency Physicians, Dr. Angela Gardner, cites:

A study just published in the Annals of Emergency Medicine shows a 9% increase in emergency room visits since the commonwealth [of Massachusetts]’s universal health-care plan was signed into law in 2006.

Dr. Gardner continues:

While the American College of Emergency Physicians supports universal health-care coverage, please do not perpetuate the myth that universal care will decrease emergency department visits. The evidence clearly says otherwise.

Thus, the drumbeat claim that government health-care will be at least partially funded by “savings” from shifting people from expensive emergency room care to affordable preventative care can now be shelved as simply another piece of “all the misinformation that’s been spread over the past few months” President Obama criticized in his Sept. 9 speech to Congress.
//end cite

http://www.independent.org/blog/?p=3461

Posted by: msoja | February 25, 2010 7:33 PM | Report abuse

--"The CBO says this."--

If I had a dollar for every million dollars that the CBO was wrong about, I'd be RICH.

Boston Globe:

//begin cite
More people are seeking care in hospital emergency rooms, and the cost of caring for ER patients has soared 17 percent over two years, despite efforts to direct patients with nonurgent problems to primary care doctors instead, according to new state data.
//end cite

http://www.boston.com/news/local/massachusetts/articles/2009/04/24/er_visits_costs_in_mass_climb/

You have to be pretty stupid not to realize that when Medicare/Medicaid is set to bankrupt the nation that SUPER Medicare/Medicaid will get the job done faster.

Bureaucrats are incompetent, and ultimately, crooked.

Our schools, solidly in government hands, are failing, but efficiently pumping battalions of morons with eyes uplifted toward Capitol Hill.

Rot.

Posted by: msoja | February 25, 2010 7:39 PM | Report abuse

Competition won't matter. It will end up being an oligopoly, 5-7 insurers or less over the whole country instead of in each state, and finally it won't reduce costs.

Posted by: Lee_A_Arnold | February 25, 2010 7:47 PM | Report abuse

--"The CBO says this."--

I actually listened a little bit to the clown circle up Obama way, today, and some Republican made the point that the CBO figures are largely based on promises that Congress has yet to undertake, like getting rid of all the Medicare/Medicaid fraud and waste (something you'd think the bureaucrats would have been on, like, decades ago, but you know, government work, and all), and the controlling of payments Ha ha ha. Yeah, that's pretty funny.

So, add in all those costs, because, obviously, the clown parade in Washington isn't going to manage those things.

And then ask little Ezra about cost control. He wants to get something (ANYTHING) passed and THEN worry about costs. He's on the record somewhere saying the country's latest run at reform, if passed, will then provide the incentive to deal with costs. That's what they did in Massachusetts, of course, and they're looking at a really big dig there...

Idiots.

Posted by: msoja | February 25, 2010 7:50 PM | Report abuse

--"Competition won't matter. It will end up being an oligopoly, 5-7 insurers or less over the whole country instead of in each state, and finally it won't reduce costs."--

In other words, it wouldn't be any worse than it is now, without costing another trillion while threatening people with taxes and jail. But, of course, yours is just bald assertion. If the market were truly set free, without the hundreds of mandates dump on it, now, insurance vehicles would proliferate. Equally of course, of course, the pols are never going to let their fingers be pried off their fiefdoms.

Similarly, to really fix health care, though, Medicare and Medicaid have to put to sleep and buried in a deep deep grave, but it was cowards who initiated the things, and no one since has been able to wrest it from them.

Likewise, we're going to have a housing crisis until Fannie and Freddie are put out of our misery. Obama sez its gonna be another year on that. Ha ha. And then maybe, another decade, or never. What a joke.

Likewise, that failure in education sitting out there waiting to express its ugly face... when it doesn't get what it thinks its owed.

Posted by: msoja | February 25, 2010 8:27 PM | Report abuse

msoja says:

"And, of course, Klein's inflated sense of his alleged intellectual superiority is only completed by the sureness of his moral superiority. He has all the components necessary to your average statist goon."

So isn't it strange that msoja is a constant reader of Ezra Klein?

Posted by: Patrick_M | February 25, 2010 8:39 PM | Report abuse

"Maybe you missed the part in which Obama explained that we're already paying for uninsured individuals and that we just don't see it. The purpose of the mandate is to get those freeloaders off our premiums."

Please drop this tired BS.
Not long ago the insurance scandal of the day was the outrageous fees that cash paying people without insurance were charged for seeking care through ER visits. Now there's a new script in town continuously parroted by EK and some posters. Fact is anyone with any resources what so ever pays to go to the ER, full boat. The only people who don't are those with no resources and they are not going to pay under the Democratic HIR plan either. In fact the plan specifically lays out how those with insurance, and those who would seldom need it, will pick up the tab. This scripting outdoes "clear skies".

--David

Posted by: davidring | February 25, 2010 9:27 PM | Report abuse

"Evolution works best when individuals are free to seek their own survival. Those with sufficient resources might feel inclined to volunteer some of those resources to enhance the survival of those they favor. Or they may not. It's a matter of one's particular abilities and predilections. The gene pool is improved one individual at a time. Those surviving most, survive best, and the herd improves.

But this ongoing nonsense of coercion and force is not really the best thing for the herd. For one thing, people chafe under the yoke, and rightly so. It's not human nature to live as a collective, like ants."

msoja,

This statement is such a crushingly dumb piece of low hanging fruit, it just begs a response.

Why do people come together in cities? Why do people form nation-states? Tribes? Religions? Cultures?

People are extremely social beings. We band together in communities. We provide for the teaching of our young people. We work together in enterprises of every conceivable kind.

Look around your house (or in your case...trailer?) right now. You are surrounded with a myriad of objects manufactured for your use and enjoyment by teams of strangers, because of complex social networks of human beings producing technology and business, the continuous development of which stretches back for many centuries.

Because we live in societies, we have a natural instinct to look after one another. That is people stop to help strangers who have accidents, and it is why firefighters rush into flames, and it is why soldiers willingly go to die in wars.

People can oppose the current health care plan for any reason that they want, including a reluctance to expend their personal funds for the health care of others.

But to argue that human beings are essentially solitary creatures and therefore selfish, and that "thinning the herd" is a proper rationale for opposing the bill, is simply laughable.

Posted by: Patrick_M | February 25, 2010 9:35 PM | Report abuse

--"But to argue that human beings are essentially solitary creatures"--

You don't know anything about evolution, do you?

How old are you, Patrick_M? I'm starting to get the impression you're about twelve.

Posted by: msoja | February 25, 2010 10:16 PM | Report abuse

Ezra's article was poorly written and confusing. Does he really have knowledge that opening up the Western states to cross-state competition won't work? What study does he quote? His own DC experience. Oh my gosh. How about a least a little research before making such stupid allegations. And oh by the way France and England have been doing this for at least a decade with their own unique HC systems and it does keep costs down and provides for prompt and efficient care.

Posted by: Dave25 | February 25, 2010 10:30 PM | Report abuse

I'm sorry although your article was very informative it but it lacks a little reality. This is what I mean. I lived in Pennsylvania and paid for my own insurance from Aetna and paid 425.00 a month. I lost my job and moved back across the river to New Jersey. Because I changed residency I had to get a new plan. The SAME EXACT PLAN that I had for 10 years in PA was 965.00 in New Jersey. By your logic, based on cost, NJ had more regulations and their for it was a better plan. IT WAS THE SAME PLAN!!!!!! As a result, I ended up getting BCBS and am still paying 425, but I only get have the services and MORE out of pocket costs. I'm sorry; your logic is flawed.

Posted by: daveku | February 25, 2010 11:07 PM | Report abuse

Msoja: "In other words, it wouldn't be any worse than it is now, without costing another trillion while threatening people with taxes and jail. But, of course, yours is just bald assertion. If the market were truly set free, without the hundreds of mandates dump on it, now, insurance vehicles would proliferate."

No, competition among insurers isn't bringing down costs very much at all, because

(1) any bargaining on prices could only be done by the biggest pools, because only they could have enough market power against suppliers -- so small new insurance start-ups won't be able to offer savings.

But (2) the big insurers don't know how to reduce costs now, because the suppliers still have more market power than they do (think AMA.)

So, the natural endgame of "cross-state competition" will be more of what we have now: is a few big insurers who have swallowed up the rest (i.e. an OLIGOPOLY,) -- and then the need for government regulation to prevent them from abusing their policyholders.

By having regulated exchanges, Obamacare jumps over the Republicans' attempt to mislead people with a phony free-market "sollution," straight to the inevitable endgame.

Posted by: Lee_A_Arnold | February 26, 2010 12:16 AM | Report abuse

Just read the article on malpractice and how it doesn't afffect the cost of healthcare. I suppose that all the extra tests that my practice performed was soley to make me millions. I, and many of my friends who were in medicine, did not start out 40 years ago doing those things. Only after the law-suit happy society we live in became the majority, did we start over diagnosing - simply to protect ourselves from some ambulance-chasing lawyer 10 years down the road. America is losing it's brightest and best in medicine solely because of the stress put upon professsionals in the only country on earth that has more lawyers than doctors. Glad I'm out.

Posted by: DrJCA | February 26, 2010 12:20 AM | Report abuse

msoja,

you are the one that sounds like you are about twelve.

Posted by: scorplar | February 26, 2010 12:22 AM | Report abuse

msoja-

No, I am not 12. Thanks for your interest, but this is really not about me.

Let me help you to understand:

My comments about the extremely social nature of human beings were made in response to your statement that "It's not human nature to live as a collective, like ants."

Yes, I understand evolution. Your contention that denial of health care to those without the means to pay will strengthen the human gene pool by thinning the herd was equally foolish, and quite obnoxious. If you believe the wealthy (say, Paris Hilton, for example) are genetically superior to the working class, you need to brush up on your science.

It really is a shame that the Republicans don't use your arguments to make their case against health care. You should call them in the morning and give them your talking points, Darwin. Operators are standing by...

Posted by: Patrick_M | February 26, 2010 12:49 AM | Report abuse

--"No, competition among insurers isn't bringing down costs very much at all, because ... "--

Um, *what* competition? Or is that a typo?

Unfortunately, these comment piles don't lend themselves to in depth analysis (nor is Klein equipped upstairs, either morally or intellectually, to explore deeper than the daily soap opera that is his and his fan's fare), but the whole idea of applying insurance to everyone is absolute nonsense from word one. Insurance applied to everyone is something other than insurance. It's redistribution, but because few people would voluntarily plow money into other people's pockets, no such universal insurance scheme would normally exist.

What's equally nonsensical is that anyone finding themselves afflicted with some malady or another would automatically assume that they could join some association for a modest fee that would then pay all their exorbitant bills.

And even more nonsensical than that is the outrage that people have that modern insurance companies aren't just SOOOOOOOOOOO pleased to have people needing expensive treatments willing to sign up for pennies on the dollar.

The whole things a f*****g laugh, and there's Klein and Crew, the very butt of it and screaming for more.

Posted by: msoja | February 26, 2010 12:52 AM | Report abuse

--"If you believe the wealthy (say, Paris Hilton, for example) are genetically superior to the working class, you need to brush up on your science."--

I don't think that "science" can tell whose DNA is superior, or that anyone can. It's life, you idiot, that does the deciding, and you think government should play god when it can't even run a railroad.

Posted by: msoja | February 26, 2010 12:54 AM | Report abuse

Msoja: "Um, *what* competition? Or is that a typo?"

Well, California Dept. of Insurance list several dozens of companies offering health insurance in Calif. -- which didn't prevent one of its largest, Anthem, from announcing a 39% rate hike.

But of course you mean race-to-the-bottom hack insurance. No guarantees of quality. And you're against universal coverage. So in another 50 years the Msoja health system will look just like it does now.

Posted by: Lee_A_Arnold | February 26, 2010 1:06 AM | Report abuse

"I don't think that "science" can tell whose DNA is superior, or that anyone can. It's life, you idiot, that does the deciding, and you think government should play god when it can't even run a railroad."

Ah! "Life" tells us that Paris Hilton has superior DNA. There is something superior about the life accomplishments of Paris Hilton that gave Ms. Hilton the wealth that will ensure she shall not worry about health care.


Please call the Republicans. They need the benefit of your clear thinking to stop this anti-evolutionary health care scheme.

Posted by: Patrick_M | February 26, 2010 1:09 AM | Report abuse

"Unfortunately, these comment piles don't lend themselves to in depth analysis (nor is Klein equipped upstairs, either morally or intellectually, to explore deeper than the daily soap opera that is his and his fan's fare),"

So isn't it strange that msoja is a constant reader of Ezra Klein, and contributes his own searing brand of "in depth analysis" to "these comment piles" on a daily basis?

Posted by: Patrick_M | February 26, 2010 1:17 AM | Report abuse

It is very odd, because his "in depth" analysis also overlooks the fact that we are ALREADY paying for the uninsured, and much more than we really have to. This is for two different reasons, because the uninsured are turning-up at the emergency rooms in the worst shape at the last minute for the most expensive care possible -- and we pay too much in a second way, because our whole society is losing its potential standard of living by lost productivity. Indeed these reasons were brought up again, at the summit today. How this could have escaped any person of analytic depth is a great mystery.

Msoja writes, "no such universal insurance scheme would normally exist." That is true, except in every other advanced country.

Posted by: Lee_A_Arnold | February 26, 2010 1:33 AM | Report abuse

I don't understand this at all. Competition? There aren't that many different health insurers left after all the mergers. Oh, there may be Anthem California or Anthem Maine but they all go back to the mothership of WellPoint.

One question I have is if I life in New York City and purchase insurance in South Dakota, would my care be considered in-network or out-of-network? Would that South Dakota insurer even have any participating providers in New York City? If so, how limited would my choices be.

This makes a huge difference in my costs since out-of-network carries a higher deductible and co-pay plus the reimbursement is made at the usual, reasonable, customary cost and not the actual charge. The provider can bill me for the difference - perhaps tens of thousands of dollars.

Components of the premium include claims experience. If my care in New York City is reimbursed at a higher rate than the same care in South Dakota, are the residents of South Dakota subsidizing my care?

This idea is a lot easier said than done and I think it is simply Republican smoke and mirrors.

Posted by: FauxReal | February 26, 2010 1:39 AM | Report abuse

"It is very odd, because his "in depth" analysis also overlooks the fact that we are ALREADY paying for the uninsured, and much more than we really have to."

Yes I completely agree, Lee, and that is true in so many ways. If there was better access to medical care, there would be more prevention and early intervention, so that many illnesses would never happen (and appear in the emergency rooms as medical disasters) at all.

Also, everyone ends up in Medicare, so if we don't pay for care now we will pay for it then. It makes sense to help folks arrive at the age of 65 in the best shape possible, not as a complete "basket case" because they have had to avoid routine care due to the expense.

"That is true, except in every other advanced country."

Exactly.

Posted by: Patrick_M | February 26, 2010 1:44 AM | Report abuse

--"the uninsured are turning-up at the emergency rooms in the worst shape at the last minute"--

You must have missed the one or two comments up above that exploded that apocryphy, on how *giving* those emergency care users free health care doesn't necessarily change their habits. In fact, it seems to encourage them.

Posted by: msoja | February 26, 2010 1:52 AM | Report abuse

ps. It's called irresponsibility, and you can't legislate it away.

Posted by: msoja | February 26, 2010 1:52 AM | Report abuse

daveku regarding the difference in the premium between NJ and Pennsylvania -

I managed benefits for a company with locations throughout NJ and Pennsylvania. Our premiums in NJ were higher than in Pennsylvania. In fact, premiums differed within both states. In NJ South Jersey was less expensive than North Jersey and in Pennsylvania the Philadelphia area was more expensive than the Johnstown area for example.

There are several components in determining the premiums and one of those components is health costs. Costs in North Jersey are more expensive that in NE Pennsylvania and in South Jersey. Those costs are used projecting claims so that policies are priced to cover anticipated claims and return a profit.

Purchasing across state lines isn't going to change that.

Posted by: FauxReal | February 26, 2010 1:53 AM | Report abuse

"One question I have is if I life in New York City and purchase insurance in South Dakota, would my care be considered in-network or out-of-network? Would that South Dakota insurer even have any participating providers in New York City? If so, how limited would my choices be."

Good question. I presume that in order to sell in your state from somewhere else, the insurer would need to create an entire new network within your state to service your policy. If everything in your state was out-of-network, nobody would buy it, because of the sky-high out-of-pocket costs.

It seems to me the only way this idea even begins to work at all would be to also scrap state regulation, and have all health insurance regulated at the federal level (to avoid the race to the bottom), and sold across all 50 states through a federal exchange.

Posted by: Patrick_M | February 26, 2010 1:54 AM | Report abuse

--"California Dept. of Insurance list several dozens of companies offering health insurance in Calif. -- which didn't prevent one of its largest, Anthem, from announcing a 39% rate hike."--

Tell me, do you really believe California hosts a free market for health care insurers?

Or are there, like, dude, thousands of pages of regulations addressing the behavior and allowable activities of the insuring types?

Tell me if you know the answer.

Posted by: msoja | February 26, 2010 1:55 AM | Report abuse

--"all health insurance regulated at the federal level"--

And every two or four years you can attempt to have your grievances redressed at the ballot box. How unlovely, and how utterly, painfully stupid.

Posted by: msoja | February 26, 2010 2:01 AM | Report abuse

"exploded that apocryphy" (apocrypha ... maybe?)

"the insuring types"

"unlovely"

Your prose is really extra special tonight, msoja.

Posted by: Patrick_M | February 26, 2010 2:07 AM | Report abuse

--"Ah! "Life" tells us that Paris Hilton has superior DNA. There is something superior about the life accomplishments of Paris Hilton that gave Ms. Hilton the wealth that will ensure she shall not worry about health care."--

I daresay that Ms Hilton supports a great number of people. Rich people generally do. And they tend to do it voluntarily. We would be sad to lose them (rich people) and quite unwise to discourage their existence.

Posted by: msoja | February 26, 2010 2:10 AM | Report abuse

"Tell me, do you really believe California hosts a free market for health care insurers?

Or are there, like, dude, thousands of pages of regulations addressing the behavior and allowable activities of the insuring types?"


Everyone can see that state regulation is strangling competition in the health insurance industry...the record corporate profits and executive salaries in those corporations demonstrate that you just can't make a nickel selling that stuff these days, the industry is withering away.

Posted by: Patrick_M | February 26, 2010 2:15 AM | Report abuse

"I daresay that Ms Hilton supports a great number of people. Rich people generally do. And they tend to do it voluntarily. We would be sad to lose them (rich people) and quite unwise to discourage their existence."

"Daresay" you indeed. Long live Paris!

Have a great evening, Shakespeare.

Posted by: Patrick_M | February 26, 2010 2:18 AM | Report abuse

Msoja: "Or are there, like, dude, thousands of pages of regulations addressing the behavior and allowable activities of the insuring types?"

It's all on-line at the California Department of Insurance.

The reasons why regulations to protect consumers would need to be eliminated, in order to allow competition, is unavailable.

The reasons are not in any economics textbook, either.

Certainly individuals here in California have plenty of choices.

Anthem hasn't claimed onerous regulations for their rate hikes. Would be quite the laugh if they tried it.

Example of any market without regulations? Credit card companies?

Posted by: Lee_A_Arnold | February 26, 2010 2:46 AM | Report abuse

Obama's "Ponzinomics" will completely destroy the country. He has no idea what he is doing and the left wing, slobbering mainstream media refuses to expose his scam. In the end, the media will be equally responsible for the decline and fall of this nation. it's a sad time for the Republic.

Posted by: rplat | February 26, 2010 8:07 AM | Report abuse

OBAMACARE YEAR IN REVIEW

This Brand New, 5-Star Hilarious and Shocking Video provides a Fast-Paced Look at the No-Lie-Too-Big, Socialist Ideologues Who Now Run Our Country.

http://www.youtube.com/watch?v=6Rv7aW3NF7w

MUST WATCH! 

Posted by: CommieBlaster | February 26, 2010 8:42 AM | Report abuse

Medicare offers an excellent template for fostering competition in the system. For six months before I became 65, I received an avalanche of solicitations from insurance agencies. Medicare provided an easy, online way of comparing free market supplemental policies, and a task that I had avoided until just before my 65th birthday turned out to be pretty easy just by logging in.

Since then, everything has worked just as it should - right down to being reminded by my prescription insurer to reorder my regular medicine.

There is competition, a thriving private insurance market, an informed client base and the precious security that comes from knowing that no one can cancel our health insurance if we become sick. We see the doctors we want; there is no government agent second guessing anybody.

And remember, in this public/private partnership, private insurers are making a bundle. Why can't anybody simply buy into this system if they choose?

Posted by: Casey1 | February 26, 2010 9:41 AM | Report abuse

Dear CommieBlaster,
The Soviet Union ended 20 years ago. You are not a conservative; you are a reactionary.

The article is right. Free markets only work when there is freedom of information. That is a hallmark of Adam Smith's theory. Without regulation, markets devolve to monopoly, which is the death of free markets - the end of capitalism. That is exactly what has been happening in this country for the last 30 years. De-regulation has given us consolidation (monopoly power) in industries and killed small businesses, small communities, banking, credit cards, drug and consumer product safety, newspapers, and health care. Don't believe me or Ezra Klein. Actually read The Wealth of Nations, and ask your mother about the past thirty years.

If you want to save capitalism and have sane, affordable health insurance, support regulation.

Posted by: Nora3 | February 26, 2010 9:46 AM | Report abuse

Competition for health care INSURANCE entirely misses the problem. The biggest problem is the lack of competition in the provision of health care SERVICES.

Because health care services have become so expensive over the last generation or two, it has become the norm to pay for them, not as we buy everything else we consume, but through third party payors, inruance, or employer or government health plans.

But third party payors have no means to control prices except making rules to ration services or otherwise deny care... since this is only marginally effective, one consequence is that the prices of health care services gets bid up ever further, and layers of complication and waste are added continuously... the problem feeds on itself.

To solve the actual problem, we'd have to go back to basics: WHY did health care become so expensive in the first place?

Could it be, in part, because Congress handed over to the AMA full control over who could PROVIDE health care services in America, and the aMA... a doctors' trade association, after all... predictably exploits this power to limit competition, and keep salaries high for its members?

These procedures were sold to the public in the name of protecting them from poor medical care, but the first effect was to eliminate competition... the single most powerful means to control prices and promote quality. What we got, instead of a free market for health care, in which the patient IS the customer, and providers must compete for the business, is a series of vast, bloated, wasteful bureaucracies (public and private: government programs, mega-insurance companies, HMOs), and health care costs rising at twice the rate of inflation.

Posted by: Iconoblaster | February 26, 2010 12:02 PM | Report abuse

--"There is competition, a thriving private insurance market, an informed client base and the precious security that comes from knowing that no one can cancel our health insurance if we become sick. We see the doctors we want; there is no government agent second guessing anybody."--

And it's going bankrupt as such a furious pace that the country is said to be in an escalating crisis.

Posted by: msoja | February 26, 2010 12:16 PM | Report abuse

--"Certainly individuals here in California have plenty of choices.
Anthem hasn't claimed onerous regulations for their rate hikes. Would be quite the laugh if they tried it.
Example of any market without regulations? Credit card companies?"--

Californians have plenty of choices from companies that are already rich enough to handle the expense of coping with the mountain of regulations in the state. And *they* aren't particularly dissatisfied with the situation. It's a form of what's known as rent seeking. The high cost of compliance helps keep competitors out, and serves to guarantee a certain market share that likewise guarantees and comfortable, steady income.

Credit card companies do NOT represent an example of unregulated markets. They enjoy a situation much like insurers. Granted, their businesses aren't yet proscribed as heavily as the insurance industry, but the government/private partnership grows, to the detriment of the earnest citizenry in general and freedom in particular.

Posted by: msoja | February 26, 2010 12:28 PM | Report abuse

Msoja, why don't you answer a prior point before going on to more nonsense?

So, returning to your point from far above, how will insurance companies under perfect competition build enough market clout to bargain down suppliers and save costs?

In your answer, please deal with the actual structure of the medical industry, not some simplified nicety.

And: What prevents the insurers from turning into an unregulated oligopoly? They are half-way there already.

Finally, why did Adam Smith write the following?

"People of the same trade seldom meet together... but the conversation ends in a conspiracy against the public or some contrivance to raise prices."

--The Wealth of Nations, 1776.

Posted by: Lee_A_Arnold | February 26, 2010 1:30 PM | Report abuse

"Lift that rule and what you have isn't competition driven by consumers, but a regulatory competition to have the laxest regulations so you have the most insurance jobs in your state."

That's correct. State regulations have caused the price of insurance in some states to skyrocket - both my mandating that all plans issued by all insurers cover a wide-range of conditions that not everyone wants insured and by limiting insurer's ability to price discriminate on the basis of risk. What lefties like Ezra fear is that the so-called 'race to the bottom' will expose the truth - rising health insurance costs (and rising health care costs) are largely driven by liberal regulations that force the young and healthy to subsidize the treatment of the old and already sick. This prices many young people out of the market and it encourages overconsumption of health care services.

Posted by: hroark314 | February 26, 2010 1:41 PM | Report abuse

--"how will insurance companies under perfect competition build enough market clout to bargain down suppliers and save costs?"--

Gosh, it's hard to say, isn't it? How did Dell computer build enough market clout to bargain down suppliers and save costs? Why couldn't Micron computer manage to do the same? Whither IBM? Where's the oligopoly? And how can health insurers be "half-way" to an "unregulated oligopoly" when health insurers are one of the most heavily regulated industries there are?

As to Adam Smith, why not give the entire quote?

"People of the same trade seldom meet together, even for merriment and diversion, but the conversation ends in a conspiracy against the public, or in some contrivance to raise prices. It is impossible indeed to prevent such meetings, by any law which either could be executed, or would be consistent with liberty and justice. But though the law cannot hinder people of the same trade from sometimes assembling together, it ought to do nothing to facilitate such assemblies; much less to render them necessary."

Posted by: msoja | February 26, 2010 1:43 PM | Report abuse

The whole Adam Smith quote is perfectly useable.

But why didn't Anthem, which has a large market size like Dell, bargain down healthcare suppliers?

Posted by: Lee_A_Arnold | February 26, 2010 2:12 PM | Report abuse

"But why didn't Anthem, which has a large market size like Dell, bargain down healthcare suppliers?"

Yes. Comparing the health insurance market to the PC manufacturers is such a flawed comparison that it is difficult to count the ways. But here are a couple for starters.

Health insurance companies are essentially in a "middle man" position, with competing incentives on the issue of cost. They need to pay providers enough to keep them "in network" (in order to keep their network big enough to be attractive to consumers), and providers like to be flexible enough on cost to keep the book of business that each insurer brings.

Neither the "suppliers" or the insurers tend to apply a great deal of leverage against one another because it is not in their interest to play hardball. The inflation goes on, and the consumer pays the price. This dynamic is completely unrelated to existing regulation.

PC's are cheaper now than 10 years ago, but the market is far less competitive. The prices went down for the simple reason that suppliers can manufacture the components at much lower cost, not because Dell exercised superior buying strategies. Dell ended up at the top of the heap for other reasons, mostly having to do with better positioning within the market and better marketing strategy, not because they built the cheapest PC (they never have). Now making PC's is so unprofitable that even Dell is looking to move into either areas, like handheld gadgets.

Posted by: Patrick_M | February 26, 2010 2:44 PM | Report abuse

Republicans and their blue dog so called democratic allies like competition only if it increases the profit of the companies that pay their campaigns. I.e. no real competition. I compared 5 or 6 different insurance companies when my insurance company, HealthNet, raised my rates by 23% last year again (the third year in a row) and found that the rates of all companies were within 2% of each other. This is NOT competition, this is a nationwide cartel protected by lawmakers who are utterly corrupt.

Posted by: simon7382 | February 27, 2010 3:05 AM | Report abuse

--"This is NOT competition"--

You are correct. The insurance companies are part of the free market in name only. They've been bastardized with government meddlings for decades. The health insurance cos resemble free market entities like night resembles day. The nearly constant refrain about their private, free market status is a joke.

Posted by: msoja | February 28, 2010 11:47 AM | Report abuse

--"But why didn't Anthem, which has a large market size like Dell, bargain down healthcare suppliers?"--

You're not getting it: Anthem is not part of a free market. Not only is its own business regulated from top to bottom, but the hospitals and doctors, which send Anthem their bills, are themselves burdened with a tremendous number of regulations, essentially killing that side of things as a market. Medicare and Medicaid mark another huge distortion in the cycle, continually shortchanging one or both members of the "partnership", and somehow getting a free pass from the stupid socialists.

Try to get it through your head that there is no free market in health care, anymore. The free market has been killed. The ongoing crisis is the inevitable result of the creeping health care socialism of the last seventy years. Any health care reform enacted this or next year will only lead to an even greater crisis in coming years.

Here's a test: If you have to get permission from someone else to set your own rates, do you own your own business?

Posted by: msoja | February 28, 2010 11:58 AM | Report abuse

Try to get it through your head that the free market never completely worked in healthcare. The regulations didn't come first. The free market crashed into patient needs, and the regulations came after.

Reasons why the free market can't completely work in healthcare? Textbook economics.

Posted by: Lee_A_Arnold | February 28, 2010 2:27 PM | Report abuse

Also, the supply-side doesn't complain about the regulations very much. They mostly complain about having to waste time dealing with insurers.

Posted by: Lee_A_Arnold | February 28, 2010 2:35 PM | Report abuse

It also doesn't make sense because the insurers are mostly complaining about the burden of regulation of rescission, and so on. Somehow the thought of enabling them to suddenly change the rules on people because their profit margins get squeezed doesn't sound like a good idea. Better to healthily regulate these insurers, make sure it is a level playing field, and then ask what prevents Anthem from bargaining down the suppliers.

Posted by: Lee_A_Arnold | February 28, 2010 2:43 PM | Report abuse

--"The free market crashed into patient needs, and the regulations came after."--

That's not entirely honest. Certainly patients had needs that they thought weren't being met, but such is the case in ANY market. Not everyone can get a giant flat screen TV. But markets have a way of coming around to satisfy everyone eventually.

What happened with health care is that some politicians decided to go corrupt, and sell something that wasn't theirs (the free market), by inserting themselves into what was none of their business. Once their foot was in the door, the rest is history, "crisis" to "crisis", with each "crisis" getting bigger and more in need of desperate solutions.

Posted by: msoja | February 28, 2010 3:55 PM | Report abuse

"Certainly patients had needs that they thought weren't being met, but such is the case in ANY market."

Such as in the failure of the market that led to Medicare?

"But markets have a way of coming around to satisfy everyone eventually."

Completely wrong. The natures of the supply and the demand matter, separately and together. And if you don't have any money, your satisfaction is omitted.

Posted by: Lee_A_Arnold | February 28, 2010 5:13 PM | Report abuse

--"The natures of the supply and the demand matter, separately and together. And if you don't have any money, your satisfaction is omitted."--

With Socialism, if you don't have the political clout, likewise.

Posted by: msoja | March 2, 2010 2:35 AM | Report abuse

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