US Health-Care Market Not Competitive

[FireNexus]

http://tpmmuckraker.talkingpointsmemo.c ... ?ref=fpblg

As Congress gets set to take up health-care reform, there's a crucial piece of data that hasn't received nearly the prominence in the debate that it deserves.

Defenders of the status quo on health care like to point out that a public option will destroy the system of robust free-market competition that currently exists.
Sen. Richard Shelby (R-AL), speaking earlier this month on Fox News, called President Obama's plan the "first step in destroying the best health care system the world has ever known." A public option, Shelby added, would "destroy the marketplace for health care."

But the notion that most American consumers enjoy anything like a competitive marketplace for health care is flatly false. And a study issued last month by a pro-reform group makes that strikingly clear.

The report, released by Health Care for America Now (HCAN), uses data compiled by the American Medical Association to show that 94 percent of the country's insurance markets are defined as "highly concentrated," according to Justice Department guidelines. Predictably, that's led to skyrocketing costs for patients, and monster profits for the big health insurers. Premiums have gone up over the past six years by more than 87 percent, on average, while profits at ten of the largest publicly traded health insurance companies rose 428 percent from 2000 to 2007.

Far from healthy market competition, HCAN describes the situation as "a market failure where a small number of large companies use their concentrated power to control premium levels, benefit packages, and provider payments in the markets they dominate."

So extreme is the level of consolidation, in fact, that one former top Federal Trade Commission official working with HCAN has sent a letter to the Justice Department's Antitrust Division, asking for an investigation into the health insurance marketplace.

The problem is most acute in small rural states, according to the report. In Shelby's own state of Alabama, the biggest insurer, Blue Cross Blue Shield, controls 83 percent of the statewide market. There, and in nine other states -- Hawaii, Rhode Island, Alaska, Vermont, Maine, Montana, Wyoming, Arkansas and Iowa -- the two largest health insurers control at least 80 percent of the market. So much for Shelby's "marketplace for health care."

The report doesn't consider how this reality stands to affect the forthcoming congressional battle for reform. But extreme consolidation may actually be making it harder, not easier, to win support from lawmakers for a public option.

That's because insurers who control large swathes of a given market stand to see their bottom lines particularly threatened by the introduction of a lower-cost public option. So, in turn, they'll be particularly aggressive in pulling out all the stops to pressure lawmakers to oppose the plan. Given the healthy amount of campaign dollars that some wavering members take in from the major insurers, that's hardly encouraging.

Of course, the Senate is where the major legislative showdown will likely occur. So in some forthcoming posts, we'll be taking a close look at just which senators have taken money from insurers who control major percentages of the state-wide market -- and where those senators stand on the public option. Stay tuned...

Here's a shocker. the free market leads to the buttfucking of consumers and rapid consolidation of businesses for the sake of larger profits. How can someone look at the way deregulated businesses become huge conglomerates and think the unregulated market is the best solution?

[Andrew_Fireborn]

Here's a shocker. the free market leads to the buttfucking of consumers and rapid consolidation of businesses for the sake of larger profits. How can someone look at the way deregulated businesses become huge conglomerates and think the unregulated market is the best solution?

Cause they're either profiting from it (Leaders and CEO-types) or indoctrinated to believe it. (FOXservatives...)

Hopefully, the tides have changes enough that it'll pass, but I'm much to pessimistic the believe that it'll be functional even if it does.

[Darth Wong]

Cause they're either profiting from it (Leaders and CEO-types) or indoctrinated to believe it. (FOXservatives...)

Unfortunately, a lot of the American nationalist mythology feeds into this delusion. The idea that the nation was created out of the principle of individual freedom and rights is very thoroughly ingrained into Americans, who are not inclined to see its inherent contradictions (state governments, by their very nature, must restrict individual freedoms in order to be functional and to provide the security and prosperity that their citizens demand). It doesn't help that certain early founding fathers made absolutist statements on the subject, such as the famous one about how he who gives up a bit of freedom for security deserves neither. Ooooh, it must be true because a dead white guy in a powdered wig said it!

The fact is that all nations expect their citizens to give up certain freedoms in exchange for security and prosperity; the question is where you draw that line, and that varies from nation to nation.

As long as you portray the state as the enemy of the peoples' "freedom" rather than a much-needed referee in a violent football game, you will always have this delusional belief that things like "freedom of choice" are automatically enhanced by getting the state out of the way, even if empirical observation shows otherwise.

[Thanas]

It doesn't help that certain early founding fathers made absolutist statements on the subject, such as the famous one about how he who gives up a bit of freedom for security deserves neither. Ooooh, it must be true because a dead white guy in a powdered wig said it!

You're strawmanning Franklin. Here is what he really said:

They who can give up essential liberty to obtain a little temporary safety, deserve neither liberty nor safety.

Nowhere did he ever say that one should not compromise and in fact he was a rather moderate voice, both in the states and abroad.

[Steve]

I suspect Mike's point is that others believe in the misquote and all it entails.

[The Romulan Republic]

I suspect Mike's point is that others believe in the misquote and all it entails.

It seemed to me that his point was that people's faith in the "founding fathers" and blind adherence to their words is causing or worsening the problem. Which is completely valid. However, that's all the more reason not to perpetuate such misquotes of the founding fathers.

[Simon_Jester]

I suspect Mike's point is that others believe in the misquote and all it entails.

It seemed to me that his point was that people's faith in the "founding fathers" and blind adherence to their words is causing or worsening the problem. Which is completely valid. However, that's all the more reason not to perpetuate such misquotes of the founding fathers.

Once the founders are given blind faith, the temptation to misquote them skyrockets. There's no real point in messing up someone else's argument unless you plan to work on the original speaker's authority.*

So misquotes of the founders wouldn't be all that significant a threat if the founders weren't getting more reverence than they deserve. Which is a very good argument for toning down on the reverence.
__________

*As an example, consider the biblical book of Deuteronomy, consisting of sermons attributed to Moses that just happened to show up on the doorstep of some prominent rabbis several centuries after Moses died. Very convenient for the rabbis that Deuteronomy supported their positions on the hot-button religious issues of the day, no? Deuteronomy was only taken seriously because the argument was attributed to Moses, an authority whose word was always taken seriously on general principles. Misrepresenting the doctrines and arguments of some random Israelite shepherd would have been useless, because few Hebrews would hesitate to disagree with a random shepherd. But if Moses said it, well then that's different, right?

[Darth Wong]

I suspect Mike's point is that others believe in the misquote and all it entails.

It seemed to me that his point was that people's faith in the "founding fathers" and blind adherence to their words is causing or worsening the problem. Which is completely valid. However, that's all the more reason not to perpetuate such misquotes of the founding fathers.

The problem is not misquoting of the Founding Fathers. It's sanctification of them. Who gives a shit exactly what they said, or which particular Founding Father said it? The point is that Americans have constructed an entire pseudo-religion around these secular saints of theirs, and it's stupid. There's a reason I didn't bother looking up which particular person said it, or which precise words he used. The point is that Americans believe the country was founded on the principle of "individual freedom" blah blah blah.

[Patrick Degan]

There's a reason I didn't bother looking up which particular person said it, or which precise words he used. The point is that Americans believe the country was founded on the principle of "individual freedom" blah blah blah.

That seems to be a fairly recent phenomenon, because that's not what I was taught in school. Then, the stress of the lesson was laid upon democratic government first, individual liberty second, and most of the lesson being oriented toward the first part. But then, I grew up in New Orleans and not the thick of Whitest Jesustan where they're still fighting the Civil War in their minds, but it seems that the lesson in schools in most of the rest of the country also primarily oriented around democratic government as the founding principle —"no taxation without representation".

[Simplicius]

"Not competitive" in another sense as well: Congresswoman Pingree (1st District, Maine) raised the point on a call-in program on public radio that the current bleating by conservatives and the insurance industry is very revealing. They whine that a public plan should not compete with private insurance without even having the details of any public plan in hand. They know that they are overcharging and underproviding, but if they can't possibly trim the fat out of their business model and change to compete with public insurance, then by the logic of the free market itself they should be left to fall by the wayside.

[Ziggy Stardust]

That seems to be a fairly recent phenomenon, because that's not what I was taught in school. Then, the stress of the lesson was laid upon democratic government first, individual liberty second, and most of the lesson being oriented toward the first part. But then, I grew up in New Orleans and not the thick of Whitest Jesustan where they're still fighting the Civil War in their minds, but it seems that the lesson in schools in most of the rest of the country also primarily oriented around democratic government as the founding principle —"no taxation without representation".

Indeed, I remember my high school history classes spending a lot of time talking about the idea of a social contract, and the balance between individual and collective freedom. I specifically remember my U.S. history teacher assigning a paper about John Locke's influence on the Declaration of Independence, and the American Revolution in general. But, then, I'm a "god-darned Yankee queer," to paraphrase Easy Rider, and not a "real" American.

[Darth Wong]

The idea of a "social contract" was discarded during the Reagan Administration.

[Lord MJ]

This might require another thread..

I was wondering what the pros and cons were of a Public Health plan where people can opt in and those that want to keep private insurance don't have to pay into the public plan. And the pros and cons of a public health plan where everyone is taxed to pay for it regardless of whether they actually use it and decide to buy private insurance.

Would an optional public health plan work?

[Darth Wong]

This might require another thread..

I was wondering what the pros and cons were of a Public Health plan where people can opt in and those that want to keep private insurance don't have to pay into the public plan. And the pros and cons of a public health plan where everyone is taxed to pay for it regardless of whether they actually use it and decide to buy private insurance.

Would an optional public health plan work?

Pros of a public/private hybrid system:

• Theoretically, given the condition that all employers are forced to allow consumers to choose on an individual basis, which they currently do not, more competition would allow greater consumer choice, with all that this entails.

Cons of a public/private hybrid system:

• Private insurers will offer severely restrictive plans for low cost, and short-sighted consumers will prefer this option even though it is essentially "insurance" in name only. Unfortunately, this means that if they ever get really sick, they are going to need some other solution. At present, we see that insurance provides little protection against serious illness because the insurance companies have made sure in their fine print that no individual customer will ever collect too many benefits.
• Insurance is based upon risk pooling, and the fact that large numbers of low-risk people (or at least people who believe they are low-risk) will prefer low-cost private insurance will make public insurance more expensive than it needs to be.

Think about how auto insurance works: if you have had many accidents, you can reach a point where no one will insure you. Conversely, if you have a clean record, you can get insurance fairly cheaply. The problem is that with health insurance, it is not acceptable to have a situation where no one will insure you. Private insurance will always subdivide customers into higher and lower risk categories, but the only way to ensure equitable distribution of health care is to eliminate this practice entirely, and force insurers to treat everyone the same. Quite frankly, private insurers would never do this. Only a public insurer would do this.

[Serafina]

• Private insurers will offer severely restrictive plans for low cost, and short-sighted consumers will prefer this option even though it is essentially "insurance" in name only. Unfortunately, this means that if they ever get really sick, they are going to need some other solution. At present, we see that insurance provides little protection against serious illness because the insurance companies have made sure in their fine print that no individual customer will ever collect too many benefits.

You can easily counteract that by passing a law that requires every kind of health insurances to cover at least what the public insurcance covers.

In Germany, we have something which can be called a hyrid of public and private health insurance (it's quite complicated).
Basically, every citizen is required by law to have an insurance (unless you earn a lot (more than 500k a year) of money, then you can choose not to have one). You can choose between private and public, but you HAVE to have some kind of health insurance. If you are unemployed, you are automatically in the public insurance. If you have a job and are in the public insurance, your employer will cover some of the costs (depending on your income, your taxation class etc.)
Public insurance is not allowed to refuse anyone to join, but private insurance can do so.

Both private and public insurance cover necessary treatments. But private insurance often offers better treatment or more choices for treatment (i.e., better teeth replacements). You also get a room on your own in the hospital, you do not have to wait as long when visiting the doctor etc. However, you can get these benefits with an "upgrade insurance" when you are in the public insurance, too.

There are, of course, some problems with this. Some people are complaining that this is creating a "two class" medical system. Also, there are a lot of legitimate complains when public insurance does not cover new or exotic treatments (i.e, accupuncture was not covered for a long time).
But it works, and NOT having an health insurance is actually quite hard.

[Darth Wong]

Private insurers will offer severely restrictive plans for low cost, and short-sighted consumers will prefer this option even though it is essentially "insurance" in name only. Unfortunately, this means that if they ever get really sick, they are going to need some other solution. At present, we see that insurance provides little protection against serious illness because the insurance companies have made sure in their fine print that no individual customer will ever collect too many benefits.

You can easily counteract that by passing a law that requires every kind of health insurances to cover at least what the public insurcance covers.

Not a realistic option in the US, where the insurance companies would fight it tooth and nail, and where it would be perceived as a form of state tyranny. The insurance companies would also jack up their prices, thus affecting countless consumers and (particularly) employers, thus causing huge fallout across the economy.

[D.Turtle]

Basically, every citizen is required by law to have an insurance (unless you earn a lot (more than 500k a year) of money, then you can choose not to have one). You can choose between private and public, but you HAVE to have some kind of health insurance.

Almost correct. You have to have earned more than about 4000€ a month for the last three years in order to be allowed to switch to private insurance.

[White Haven]

To put that in perspective, according to Germany I would need to make roughly three to four times my current pre-tax pay in order for my uninsured ass to be allowed to pay for my own insurance out-of-pocket.

[Serafina]

To put that in perspective, according to Germany I would need to make roughly three to four times my current pre-tax pay in order for my uninsured ass to be allowed to pay for my own insurance out-of-pocket.

Well, that may be, but since when is having a free health insurance a bad thing?

[White Haven]

That's rather the point I was making, dingbat. I was taking an example of a first-world nation assuming that until you make FOUR TIMES what I do, you shouldn't be allowed to opt OUT of free health care, because said country's government doesn't think it's a reasonable risk to the person involved.

[Serafina]

That's rather the point I was making, dingbat. I was taking an example of a first-world nation assuming that until you make FOUR TIMES what I do, you shouldn't be allowed to opt OUT of free health care, because said country's government doesn't think it's a reasonable risk to the person involved.

Oh, then i am sorry for being dumb and completly misreading your post .

[Glocksman]

To put that in perspective, according to Germany I would need to make roughly three to four times my current pre-tax pay in order for my uninsured ass to be allowed to pay for my own insurance out-of-pocket.

Count yourself lucky.
I make twenty times less than that.

That said, I have damn good health insurance thanks to my union.
I may not make shit for hourly wages ($13.20/hr) as a forklift/power equipment operator, but I do have a decent 90/10 insurance plan with a $500 maximum 'out of pocket' limit*.

Prior to our current contract, the insurance was 100% coverage with smaller copays for routine visits and prescription coverage.

As a certified PEO, I could easily switch employers and make more on the hour.
The problem is losing my insurance, as I have both an artificial heart valve and a pacemaker.

The employers who'd pay me more don't offer good insurance, and to be frank, losing my insurance would only insure that I'm in an ER six months from now suffering from a stroke and/or heart failure.

And since the ER can't deny me lifesaving treatment, the costs involved are far more than those involved in monitoring my pacemaker, INR levels, and paying for a warfarin prescription.


*Copays are not counted when calculating the 'out of pocket' expenses.

[Big Orange]

OK, over Spacebattles.com we've got a heated debate about FHC between the saner board members and resident LOLbetarians. This reply from one of the LOLbetarians is just golden:

What?

It's the public education system that's failing man.

You people need to drop the rhetoric and pick up some substance. It seems you've all got the left-wing brain bug that more government = good and anything private = bad, to the point where you don't bother to check whether or not what you believe is true or not.

I'll admit I've been wrong before. Heck, I'm probably wrong about a lot of things right now. But at least I have the balls to try and check the facts, instead of just hoping and praying that the news media is reporting the truth to me.

You want to know what America needs? America needs a Great Depression. We need a time when you need to stand in a bread line and there's not enough money to pay the garbage man, let alone universal healthcare. We've had so many decades of unparalleled prosperity that we've lost all perspective. Poverty of the sort that dominated human history up until 60 years ago simply doesn't exist here. I mean, people are worried about those with incomes in the area of $20,000 a year not being able to get health-care? Psh, that ain't shit, think about your grandfather who had an income the equivalent of $1,500 a year not being able to get a house or even a fucking apartment.

People don't expect to have to work for anything anymore. If I feel I deserve it, just for existing, then damn the government better be ready to provide it for me. Cause you want to know what the health-care crisis facing the Western World is right now? And believe me there's a health-care crisis in Europe and Canada, too. When people are dieing in waiting lines for surgery that's as much a crisis as when they die after being rejected by their insurance company. The health-care crisis facing the Western World is that we've got more leisure time than ever before in human history, and yet fewer and fewer people are going out to be doctors, and surgeons, and bio-tech engineers. Everybody wants to do a simple and easy service job with high pay and benefits. Anything their employer can't afford to give them should be given to them by the government.

You want to know what's failed? This idea that passing a law can solve our problems. But the truth is, only we can solve our problems. Today we've got technology they could only dream about 200 years ago. Imagine what we could do if we had their work ethic. But we don't, we expect somebody else to do the hard part for us.

And meanwhile, all the fallout from our centralization based policies is biting future generations in the ass. Inner-city kids are fucked over by the system which refuses to do anything about their shitty public schools. Any attempts to give them school choice is blocked by greedy teacher's unions, which care more about a steady paycheck than the well-being and education of the children. We're heaping uncountable debts on their heads before they even really understand the concept. We're letting our morality run un-checked over their future. We think the government is just one big person that should operate like we all do, never quite getting the big picture.

What we need is a swift kick in the arse.

Link

Apart from the comment about teacher's unions, the rest of what he says is concentrated lunacy. I'm too tired (and lazy) to break down his reply in detail, but he really wants the basic support to US citizens to be cut off and then plunged into even deeper poverty than they're in now. Misanthropes, why the fuck did they get so powerful?!

[Darth Wong]

Classic case of projection. He assumes that all private industry is good and all government is bad, and he assumes, with no real evidence, that his opponents have the exact opposite view. If that were actually true, then there would be people saying that 100% of private industry should be nationalized. Who is saying that? Nobody, except the strawmen in his head.

His belief that UHC is a wealth-driven idea is utterly preposterous. Guess when Europe started instituting universal health care: after WW2. Tell me, were they swimming in money at the time? NO! In reality, spoiled-rotten wealth has been the thing preventing adoption of UHC in the United States, not the thing driving it. When people are truly suffering, then they are more willing to recognize what is essential: people have a right to basic necessities of life. When people are doing well, they can delude themselves into treating other peoples' medical requirements as if they are a luxury, or an abstract philosophical concept.

This guy's grasp of history is comically bad. He thinks that another Great Depression would drive people toward laissez-faire capitalism, even though the last Great Depression drove people toward market regulation and socialism.

[K. A. Pital]

This guy's grasp of history is comically bad. He thinks that another Great Depression would drive people toward laissez-faire capitalism, even though the last Great Depression drove people toward market regulation and socialism.

He probably thinks the last Great Depression ended when people saw the light of the Worker and Kolkhoz Woman Reagan and Rand coming with a hammer and a sickle a dollar and a book. Or maybe he's just pathetically stupid and badly educated, as are many, many Americans.

To be frank, the level of American fascination with "socialism" is really funny - I think 90% of the people who rant about "socialism in America" every week and create new threads about "socialism" really don't know what socialism is. They also don't know that America will not see anything like socialism in another 100 years due to the prevailing ideology in the society, but still discuss "socialism" and it's "threats" every sunday.

What a bunch of jerks.