The United States is out of control

[FlashLackey]

Competition has not brought down heath care costs nor has it improved heath care coverage.

That's because there isn't normal competition in the health care industry. Insurance companies don't compete across borders and in the vast majority of cases they don't compete for the actual consumers business since the policy is chosen by an employer.

Which is exactly why I say my support for free market starts after basic human needs are met. My illness should not buy you lunch.

I see it as the opposite. Because health is so vital, it is even more imperative that we take full advantage of the benefits of competition and not impede it.

As you mentioned, competition provides lower costs and improved products. Someone profiting from curing your illness should be more palatable when you realize that the cure may not have been invented to begin with if someone wasn't well motivated to figure it out.

[Loyal Rogue]

That's because there isn't normal competition in the health care industry. Insurance companies don't compete across borders...

I don't understand why this is even an issue with you?
All insurance companies are under the same rules when it comes to selling within a particular state.
How is that not normal competition???

If an insurance company wants to sell policies in a particular state all they have to do is open an office there and follow that state's regulations just like every other insurance company.

The only thing you are advocating is the ability to be able to sell policies in a particular state while ignoring any regulations and laws of that state.
Kind of like opening a "corporation" using a PO Box in the Bahamas and then doing business in the US while avoiding the taxes and laws that every other US based business must adhere to.
Why must "normal competition" to you equal unfair business practices?

[jAQUAN]

I agree with your logic FL but I don't think it's that cut and dried when it comes to how insurance companies make money. The mindset behind insurance is fairly sound. Multiple people pay into a system so that when a percentage of them need help, there's a collective coffer to pay for their care. As long as less people need help than pay into the system, the provider turns a profit. Sounds dandy... except for the need to appease shareholders. Usually that means yearly profits need to head in a general direction. Up.

Now if I'm head of the company I might think I'm a genius for figuring out that if I can reduce the number of claims I have to pay out, I not only get to stop worrying about profits, I can guarantee them. You'd have to grow up under a rock to assume they aren't going to take steps to make that a reality. Enter market competition. Wouldn't they just approve more claims therefor increasing their status and in turn take your customers? No way the same idea would be appealing to them as well right? If this idea become so pervasive that it's standard provider practice, who's going to call foul loud enough to put a stop to it? Clearly the people are going to cry out for laws preventing such practices. But now the problem, the providers are hauling in inconceivable amounts of money due to the fact that any independent company who wants to retain their staff has to buy these goods. That's enough money to literally buy a law. Again, you've never been outside if you think there's enough altruistic politicians who would turn down gobs of soft money. You can see already by this point that gop claims that a bureaucrat getting in the way if your health care is hypocrisy at best. They've been in the way from the word go. In the rare case you get both an honorable provider and enough loyal politicians who attempt to turn the tide, it's a matter of time before they go under from "competition".

Now you might be able to argue that since it's a similar situation across the board you have a level playing field. There's only one thing missing, and that's options. So if you eliminated risk and the consumer option, how is that a free market system anymore? It's every bit as fk'd as what we're being warned against.

You don't buy an iPhone, leave it at the store and hope it's there every time you want to use it, why the hell would you accept those terms when your health is involved?

You speak of motivation. Can you imagine what kind of projections you'd have to have in front of you to want to try making money another way? It's inconceivable.

Now I'm not saying a global system would be immune to such corruption, but under the right leadership and proper motivation (ie. being paid for results) there's at least a chance.


Now take big pharma. Make a better medicine, make more money. Sweet! But with billions in research, an imperfect science and a ton of law suit risk, how long are you going to be able to afford the high road? Enter deregulation. For a third time, you'd have to be completely disconnected to think any politician or political group who desires re-election would take it upon themselves to open such an irresponsible floodgate. And yet it happened. Now your medication can give you hot-dog fingers and two *ss-holes as long as you sell enough to afford the drop in the bucket a class action law suit would cost should you actually be out lawyered and lose a court case.

The very worst part? A doctor has to step over his/her Hippocratic oath to get anywhere near zero after school loans and malpractice insurance are paid. With providers on one shoulder and pharmaceutical kickbacks on the other, how is there going to be enough motivation to improve care?

And then I read the gop claims to reduce costs here and increase effectiveness there without the slightest hint they actually want to change business as usual.

To reiterate, in this idealistic fantasy where everyone does the right thing, I'd say change is a bad thing. But you'd have to believe an omnipotent power leveled the walls of Jericho to think that's how it is.


Please keep in mind, this is only one entire post making only one entire point. To find fault with a few words or statements for the sake of rebuttal serves only one person.

[FlashLackey]

I don't understand why this is even an issue with you?
All insurance companies are under the same rules when it comes to selling within a particular state.
How is that not normal competition???

How is it normal? With the exception of alcohol and guns, what other product or service is limited from being sold in this way? I once had auto insurance in California from a company in Oklahoma.

If they had to compete on a larger stage against more companies and for more consumers, they would be under more pressure to keep prices down while still offering a competitive product. Just like every other company that sells products in a normal competitive market.

If an insurance company wants to sell policies in a particular state all they have to do is open an office there and follow that state's regulations just like every other insurance company.

Not if the state won't allow it. Blue Cross of Kansas is not just an additional office of Blue Cross. It's a separate company. They aren't competing with any other company or for consumers in any state other than Kansas.

If Blue Cross were stationed in Kansas and anyone in the US could buy their policies. Every other company in the US would have to compete with them for the business of every consumer in the US. See how competition would be increased under those circumstances? See how that is how the market works for most products under normal conditions?

The only thing you are advocating is the ability to be able to sell policies in a particular state while ignoring any regulations and laws of that state.

No. I'm advocating that if people in Kansas enjoy lower cost health insurance than those in California. It would benefit Californians to be able to buy lower cost health insurance from Kansas.

Why must "normal competition" to you equal unfair business practices?

What about being forced not to buy a product that is perfectly feasible to deliver and is in demand is a fair business practice?

Now if I'm head of the company I might think I'm a genius for figuring out that if I can reduce the number of claims I have to pay out, I not only get to stop worrying about profits, I can guarantee them. You'd have to grow up under a rock to assume they aren't going to take steps to make that a reality. Enter market competition. Wouldn't they just approve more claims therefor increasing their status and in turn take your customers? No way the same idea would be appealing to them as well right? If this idea become so pervasive that it's standard provider practice, who's going to call foul loud enough to put a stop to it?

It sounds like what you're describing is collusion where all the competing companies agree not to lower their rates against each other. That is already illegal. Due to the complexity of adminstration of publicly traded, national companies, it would take such a vast conspiracy to pull something like that off that it's very unlikely to happen on any broad scale. Besides, the benefit of simply ignoring such a conspiracy and undercutting everyone else would outweigh the risk/reward of gaining maybe more profit through collusion at the risk of being involved in a major scandal.

Now you might be able to argue that since it's a similar situation across the board you have a level playing field. There's only one thing missing, and that's options. So if you eliminated risk and the consumer option, how is that a free market system anymore? It's every bit as fk'd as what we're being warned against.

Options are of value to customers. More competition would most likely motivate insurance companies to create various types of plans to choose from, depending on whatever trends that market might take. Similar to how auto insurance companies are always coming out with new types of policies that give rewards for this or that.

The very worst part? A doctor has to step over his/her Hippocratic oath to get anywhere near zero after school loans and malpractice insurance are paid. With providers on one shoulder and pharmaceutical kickbacks on the other, how is there going to be enough motivation to improve care?

Winning market share. When a market has healthy competition, price is only one component. When the lowest feasible price is established, the only way left to make more profit is to win a larger market share from your competition. That is typically done with quality or features that your competition doesn't have.

[jAQUAN]

@FL
1) Yes, I am describing collusion. Who enforces that law on 1,300 companies?

2) Agreed, but ultimately it's the employer who makes the choice. The employee is usually left with choosing among 3 levels of co-pay directly related to the type of care, most of which do not cover major procedures or things like mental health. Employers who have a bottom line to worry about are arguably going to choose the cheapest broadest plan (which are carefully constructed to sell a specific model much like apple computers). But we're not talking about choice, we're talking about abuse of power in order to create the illusion of choice.

3) That may pertain to altruist pharmaceutical companies and health care prevent- er I mean providers, but my last point focused directly on doctor/patient relations. I'm not sure how the approved practitioner lists are assembled for a given plan but the average holder is certainly not free to choose any doctor or hospital they want so what does market share really reflect if ultimately public and private practices are only competing to get on the most lists? I doubt that providers are adding to those lists practices who intend on submitting the needed amount of care for each and every patient. A private practice is heavily dependent on reimbursement from providers and after the honeymoon is over, few are going to bite the hand that feeds them.

[FlashLackey]

@FL
1) Yes, I am describing collusion. Who enforces that law on 1,300 companies?

The DOJ and the FTC.

And this supports my point about the feasibility of such collusion. If all 1300 companies are competing against each other, how realistic is it that all 1300 organizations would be able to or would at the same time be interested in a collusion conspiracy? Remember that collusion doesn't work if a few or even one undercuts everyone else because they would just get a windfall of market share from the rest.

2) Agreed, but ultimately it's the employer who makes the choice. The employee is usually left with choosing among 3 levels of co-pay directly related to the type of care, most of which do not cover major procedures or things like mental health. Employers who have a bottom line to worry about are arguably going to choose the cheapest broadest plan (which are carefully constructed to sell a specific model much like apple computers). But we're not talking about choice, we're talking about abuse of power in order to create the illusion of choice.

I agree that the employer provided health care model also prevents competition. That's why my position includes removing the subsidies that encourage it and using that money to fund a voucher for every US citizen. That would be an avalanche of competition over night.

3) That may pertain to altruist pharmaceutical companies and health care prevent- er I mean providers, but my last point focused directly on doctor/patient relations. I'm not sure how the approved practitioner lists are assembled for a given plan but the average holder is certainly not free to choose any doctor or hospital they want so what does market share really reflect if ultimately public and private practices are only competing to get on the most lists? I doubt that providers are adding to those lists practices who intend on submitting the needed amount of care for each and every patient. A private practice is heavily dependent on reimbursement from providers and after the honeymoon is over, few are going to bite the hand that feeds them.

Being able to choose any doctor is a desirable feature that people are willing to pay for. We opted to pay a higher deductable in order to have a PPO plan that let's us choose from many more doctors than the cheaper HMO would have.

So, people who choose their plans as I would like to see all people doing, already have the option between cheaper+limited doctors or pay more+more doctor options.

[jAQUAN]

I think you should prevent a lot of misinterpretation by setting a ground rule of you define liberal and conservative as.

Some good insight on this about half way through. http://www.time.com/time/video/playe...5001_0,00.html

bonus: a race to the bottom http://www.time.com/time/video/playe...0001_0,00.html

[jAQUAN]

The DOJ and the FTC.

Please be more specific. http://en.wikipedia.org/wiki/United_...e#Organization

There are no concrete examples that I could find that proved the DOJ or FTC as corrupt but it seems to be all I hear about sometimes. Just saying it's not a perfect world and there's no reason to assume they are perfectly effective.

how realistic is it that all 1300 organizations would be able to or would at the same time be interested in a collusion conspiracy?.

Doesn't take 100% participation. https://catalog.ama-assn.org/Catalog...Id=prod1350008

A single company like Microsoft can still influence the W3C to use a poor but accurate example.

[FlashLackey]

Please be more specific. http://en.wikipedia.org/wiki/United_...e#Organization

There are no concrete examples that I could find that proved the DOJ or FTC as corrupt but it seems to be all I hear about sometimes. Just saying it's not a perfect world and there's no reason to assume they are perfectly effective.

They don't need to be perfectly effective because there is already motivation not to collude built into capitalism. As I mentioned, if two companies collude with higher prices and a third company under-cuts their price, it makes the collusion damaging to their business and adds risk of scandal.

Doesn't take 100% participation. https://catalog.ama-assn.org/Catalog...Id=prod1350008

A single company like Microsoft can still influence the W3C to use a poor but accurate example.

That article supports my position. It's saying that the lack of competition in many states allows a few companies to dominate the market and raise prices. That is due to near monopoly circumstances rather than collusion.

If insurance companies had to compete nationally for every consumer of insurance plans, none of them would have the market dominance that many of them currently enjoy.

[jAQUAN]

I can definitely get behind a national fairness policy.