I keep seeing this idea to deregulate health insurance everywhere- there is an editorial in the WSJ, Reason loves it (shocker!), and E.D. Kain thinks it is a great idea.
My question- why does everyone think this will be such a great thing? Won’t the exact same thing that happened with credit cards happen with health insurance? They’ll just buy a state legislature somewhere (maybe North Dakota or Delaware), and everything will then be a race to the bottom.
Am I wrong about this?
eldorado
that’s exactly what it will look like. terms and conditions subject to change without notice.
MBSS
don’t let your facts get in the way of my ideology, john cole. or i will cover my ears and hum, or go to a town hall packing heat, or some such other inanity.
if it’s good enough for ayn rand then it’s good enough for me. you guys are holding us “exceptionalists” back.
ellaesther
No, you are not wrong.
Yes, you are absolutely right.
The nail – she is hit on the head!
Etc, etc, etc. De-regulation of the people who do, quite genuinely, already stand between me and my doctor is an unfathomable recipe for disaster.
(Presumably, cutting taxes will also help with this effort. It helps with everything!)
Shygetz
I don’t think deregulation is the answer, but perhaps moving regulation to the federal level and opening up interstate insurance competition might be a feasible way to go if the federal regulation is VERY robust–but I’d MUCH rather have Canadian-style single payer.
gex
The definition of crazy. Every time we encounter a problem, let’s deregulate. The fact that many of our biggest problems now are caused by deregulation doesn’t really bother limited government types at all.
What bothers me most are those who by default oppose government intervention in markets based on principle. It’s like none of them give two shits about competitive markets. Capitalism eats itself if governments don’t make markets competitive. You can see this already in health care given the obscene profits the insurance companies make. Where are the competitors driving prices down?
aimai
No. You are not wrong.
This has been a simple answer to a simple question.
Roger Moore
Because they think that regulation is inherently evil, so anything that will reduce regulation anywhere is a great idea. I think that many of these people would have benefited from increased regulation about the use of lead in children’s toys, since they obviously suffered irreparable brain damage from something. Maybe they just need to be sent for glibertarian deprogramming.
moe99
What aimai said.
Johnny Pez
Just think of all the potential Bernie Madoffs out there waiting for the chance to enter an unregulated health care market. Free markets and free minds!
FormerSwingVoter
I can’t help but think that the new federal regs in the reform bill will render most of the state-level stuff moot anyway. Am I wrong here? Community rating seems redundant if they can’t charge you or your employer extra for a pre-existing condition.
LITBMueller
Yeah, we saw how well deregulation of the banking industry worked out this past decade. Great success!!! Also, check out NY State for a primer on how health insurance deregulation has worked out. Since 1996, NY State government is prohibited from reviewing/approving premium increases by private insurers.
Karen
Deregulate the insurance industry? Let’s ask all the people who live up and down the Atlantic coast how much they’d like to go through a few rough hurricane seasons with a deregulated industry.
superfly
You are right, but here’s the irony, the insurance companies probably don’t even want that, since right now, they actually have a bunch of little state-level near monopolies.
If they had a choice, they take the deregulation over actual reform, but what they really want is the status quo.
Tom65
These fuckers have been killing people for decades, all in the interest of profiting off illness. Can you imagine the shit they’d pull if they were deregulated?
El Cid
And then we could trade Credit Default Swaps on health insurance policies! What could go wrong?
cmorenc
From a laissez-faire business wing of the GOP sort of perspective, that’s precisely the most important aim of “leaving experimentation up to the states” and setting up schemes where corporations can pick and choose the state with the most minimalist business-friendly regulatory environment, and then either be effectively able to operate in all 49 other states under the chosen state’s minimalist scheme (in the case of commercial sales) or else move operations to the most minimalist state (in the case of e.g. manufacturing or distribution plants).
This has two benefits:
1) For many purposes, it allows corporations to effectively override and ignore the regulatory schemes in less cozily friendly states, and operate in those other states as if doing business in the more friendly one;
2) In situations where scenario #1 doesn’t fit well for one reason or another, force states into a “race for the bottom” in consumer protection, environmental protection, anti-fraud laws, etc. etc.
It’s not as if the insurance companies which set up in states where it’s possible to give the lowest quote rates aren’t getting to hold something back from consumers in exchange – you betcha there will be tons of “gotchas”, quid pro quos, provisos, etc permitted in such out-of-state plans which enable the insurance companies to minimize their exposure to claims in ways the consumer who thought they were getting a great deal wasn’t expecting come crunch-time.
Joshua Norton
Whenever I hear the word “deregulation” all I can think of is the song and dance the repiggies gave us in California when they promised us lower energy prices if we’d only deregulate public utilities. That worked sooooo well that I’m now paying 125$ a month for a 1 BR apt. When the evil regulations were in place I was paying 18$ a month.
So yeah! Sign me up. What could possibly go wrong?
ominira
Deregulation has worked wonders in the banking sector. Of course it will be fantastic in the health sector. Just like credit card companies, your health insurer will be able to change your premiums with very short notice & cancel your coverage when they feel like it. Oh wait, that’s already happening?
What I wish someone would do is argue for a model similar but not identical to Singapore’s which blends some of the features that conservatives like (self-reliance – everyone has to have a health savings account) with features that others like (government pays for basic healthcare expenditures & expenditures in excess of health savings). Plus public and private health insurers compete (there are still private health insurers in Singapore just as in the UK and Canada). The health outcomes are also pretty good for a lot less spending than the US.
Sentient Puddle
I don’t know, either you’re reading wrong, I’m reading it wrong, or someone somewhere is experiencing some massive form of cognitive dissonance (or some combination of all of the above). You can say you want deregulation, but then if you go on to say that you want…
…then you’re calling for more regulation.
This all said, I don’t think anyone who knows what they’re talking about calls for blanket deregulation in any aspect of the market. If they say they’re for deregulation, but not pinpointing what exactly they want to deregulate, then you can be reasonably certain that they’re a high schooler who just read Atlas Shrugged for the first time.
Downpuppy
There are already unregulated states out West. Every discussion brings out people paying $100/month. None of these people have had serious illnesses, so they still THINK they have insurance.
With credit cards, once the bills blow up, people can just quit paying. At that point its Bad Credit rating? Annoying collectors? Wooooooo, Scary! Somebody has bigger problems.
When health blows up, it’s much, much worse.
People talking deregulation are just being assholes, and should be treated accordingly.
Fwiffo
Deregulation (e.g. deregulation of financial industry over the last decade) is one of the idiotic catch-alls for modern conservatism, right up their with anti-intellectualism (global warming, creationism), tax cuts (look at that awesome jobless, wageless recovery spawned by the Bush tax cuts), privatization (Bush’s SS boondogle, Blackwater mercs, etc.), etc.
DougL (frmrly: Conservatively Liberal)
Let’s just deregulate everything and see how that works. After all, businesses will never kill their cash cow, right? Let’s just have a free-for-all and let business run everything (into the ground).
What could go wrong?
E.D. Kain
It’s not merely “deregulation” as though this were sort of a panacea or rather a sort of one-size-fits-all thing. Deregulation should be coupled with new, smarter regulations. Would you trade the tight, monopoly-creating regulations we have today for regulations that do away with pre-existing conditions clauses? Is it possible to keep regulations that protect consumers while losing regulations that hinder competition? I think so.
When we are given no choices, no exit, no alternative – in other words, when we have monopoly as we largely do now – we are at the mercy of the insurance companies. When they are
allowedforced to compete, consumers benefit. This is not to say we should do away with all consumer protection, or go the route of the credit card companies (though I would say the scenarios are actually quite different).In short: increase competition and consumer protection, as the two go hand in hand.
flounder
This has been Enzi’s wet dream for a long time.
Mark S.
Because that’s their solution to everything. The free market is always the most efficient, no matter how much evidence you muster to show that sometimes it is not.
Deregulation, capping malpractice awards, insurance insurance, taxing employer provided insurance: these are all terrible ideas that will make the situation so bad that people will be screaming for single payer. These goofballs are so wedded to their ideology that they can;’t see it.
General Winfield Stuck
Well that’s just great, now my mailbox will be filled with instant pre-qualified health care deals with kazzillion dollar yearly membership fees and a murky “bend over while we fuck you clause” written in invisible ink.
MBSS
@joshua norton
as a fellow joshua and fellow californian, i would have to agree. i remember those “enron rolling blackouts,” from a few years back.
kay
@FormerSwingVoter:
This is a little different than that. There are barriers to insurance companies operating across state lines. The barriers are different regulatory structures. For example, my state forces insurers to cover all manner of organ donations, even experimental. I actually found this out from personal experience. That was put in place by my state legislature, luckily, as it turned out. If I’m a company that doesn’t cover those, I can’t offer a policy in my state.
What they want to do is remove those barriers.
The state where the policy is issued would govern, so naturally insurers would flock to less-regulated states.
You would buy a policy that originates in unregulated North Dakota, and rely on it in regulated Connecticut.
TimmyB
Deregulating the insurance industry is a “great idea” if you are part of the insurance industry, or one of its whores.
For average Americans its a crappy idea.
Hunter Gathers
“In short: increase competition and consumer protection, as the two go hand in hand.”
Now, I can’t put my finger on it, but I think I’ve heard this somewhere before.
Let’s see……increased competition? Public Option would do that. Increased consumer protections? Like no more ‘pre-existing conditions’, etc., etc.?
Sounds like the plan currently being worked on in Congress.
Congratulations Mr. Kain, you have just convinced me that libertarians read nothing but Ayn Rand novels and Ron Paul’s latest whack-a-doodle newsletter.
kay
@FormerSwingVoter:
And, swing voter, the new federal regs in the reform bill are not the model here.
The group who want to trump all that state law with what we can assume (because they’re conservatives) is a looser federal regulatory structure, are only mandating one requirement: that the insurer take all comers.
But what does the insurer have to offer in exchange for that?
I mean, that’s going to be very important to you if you purchase the policy, or you’re going to have a really nifty contract, suitable for framing, and you’re “insured”, I guess, but what if it doesn’t cover anything? You’re going to be really, really disappointed, and bankrupt, too.
Jennifer
When we deregulated energy markets, we got Enron and rolling blackouts.
What will we get with deregulated health insurance markets? My guess is gaming of the system by Aetna, Kaiser, etc and lots of dead and sick people.
DougL (frmrly: Conservatively Liberal)
I learned long ago that if Republicans and business are for something then we the public are screwed. It’s been that way for over forty years and I don’t see it changing any time soon. Every single time they say something is good for us it ends up fucking us over.
It’s as sure a thing as shit stinking. Opposite Day is a way of life with these assholes.
ominira
@kay:
Thanks for this. Now I think I understand a bit better. The problem is then that if the federal government tries to come up with some minimum standards that health insurers must meet, it becomes a states rights issue (if state x doesn’t think there should be any regulations at all).
kay
@Hunter Gathers:
And, who oversees that reserves cover potential liability? Like, the SEC or something? That’s money in the bank.
kansi
Book it: Montana will be the epicenter.
Dr. Loveless
Because snuffing Granny would be done much more efficiently by an Invisible Hand.
Joshua Norton
Has there EVER been a case of deregulation working out the way it was promised? It’s always been geared for the benefit of one particular person or company, but being passed off as something wonderful for all of us.
Don’t wingnuts ever look back and at all the rubble left in the wake of their grand deregulation schemes and realized that it was a horrible idea? Their pie-in-the-sky theory and ideology hasn’t worked, but they never stop pushing for it.
Tonal Crow
We had nationwide deregulation in the patent-medicine era. It led to high prices, shoddy (and ofttimes deadly) merchandise and services, and company towns run like Soviet gulags.
Those who deplore learning from history condemn the rest of us to live through its repetition.
kay
@ominira:
Well, nominally, but even Republicans know they have to force insurers to take all comers. That’s the bottom.
The question is offer WHAT to all comers.
Indylib
OT
The irony bug bites – hard. Michelle “Whackadoodle” Bachmann’s son joins the TFA – Teachers for America, part of AmeriCorp.
http://www.startribune.com/local/53002167.html?page=2&c=y
I wonder if she has plans to getting him un-re-educated?
JK
OT
Diane Campbell of Kingston, N.H., held a sign with Mr. Obama’s face superimposed on a Nazi storm trooper, a sign, she said, that was made by her chronically ill mother.
Her mother’s hereditary autoimmune disease is treated with expensive transfusions of gamma globulin, paid for by Medicare. Her sister, Louise, was born with no arms and one leg, and is also covered by Medicare, the government-run, health-insurance program for the elderly and disabled.
“Adolf Hitler was for exterminating the weak, not just the Jews and stuff, and socialism — that’s what’s going to happen.”
h/t http://online.wsj.com/article/SB124999368750322533.html#mod=todays_us_page_one
BFR
Has there EVER been a case of deregulation working out the way it was promised?
You can make a case for the airline industry. Deregulation sucked for people who had jobs with legacy carriers or who lived in rural areas but it did bring a great deal of increased competition on major routes and created a space for low cost carriers to emerge.
joes527
John – you are missing the big picture. This would allow the insurance companies to write policies like there was no tomorrow. Everyone would be covered in a month once there is no downside to writing a policy.
In order to maintain the “no downside” bit, the policy writers will then bundle up everything they have into a security that no one can figure out the worth of, and then sell these to banks as investments.
We will need to insure these securities, and … what the hell, let’s let folks who have no stake in the policies at all take side bets on them defaulting and call THAT insurance also.
This is a win-win-win.
Demo Woman
@kay: How was your meeting with your right wing rep?
kay
@Joshua Norton:
I think it’s so chintzy. It’s just a pass the buck. We can then crow that everyone’s “covered”, until the horror stories start rolling in.
People couldn’t decipher mortgage agreements. They can’t read their credit card contract. They’re going to be able to negotiate on an even playing field with health insurers?
MBSS
i mean, there’s a reason we wanted to regulate in the first place. do we have some kind of collective alzheimers? let’s just go back to the heyday of the industrial age, and get 12 year olds in soot filled factories, working 18 hour days.
Seebach
Teabagger tearsup picture of Rosa Parks. This will end well.
church Lady
I thought that the idea of “deregulation” was to make the purchase of health insurance across state lines available in the way that car insurance is. Is this not correct? The way that I understand it, currently health insurers have to be on a state’s approved list and quite a few, if not all, states have regualtions as to what insurance companies must cover, which, if the benefits are generous enough, drives up the premium cost.
I guess it depends on what each individual is looking for in coverage. If I wanted a plan that provided everything under the sun, I might want to buy from a company that operates in a state mandating generous benefits. If I just wanted bare bones catastrophic coverage, I could buy from a company operating in a state with less stringent benefit rules. Isn’t this what so many are talking about?
Tsulagi
Deregulation, at least not bound by individual state regulation and insurance commissioners, and health co-ops is how Pubs and insurance companies want to gut if not kill public option. Given they’ve brought out crowds to be mad at the Democrats and call them names, and given the Dem track record on picking battles and keeping their powder dry, give it better than even odds they’ll win. Bipartisanship.
Demo Woman
Kain’s had a list of concerns, one being
Deregulation could lead to more monopolization.
scav
@BFR: yeah, and for the price of a ticket you can get the equivalent of a mandatory hotel room on the tarmac overnight AND no peanuts! Mixed blessing at best.
Tony J
Don’t wingnuts ever look back and at all the rubble left in the wake of their grand deregulation schemes and realized that it was a horrible idea? Their pie-in-the-sky theory and ideology hasn’t worked, but they never stop pushing for it.
Of course not. All they see is that there must not have been – enough – deregulation, since things got worse. And that’s obviously the fault of the Democrats, because they hate America.
kay
@Demo Woman:
Not well. It was for 8:30, I got there on time, he was a little late, which made him defensive, I think, or maybe he’s just cranky by nature. I actually said “settle down” which is what I say to my teenage clients, so I’m a little embarrassed about that. That’s probably patronizing, right?
Anyway, no meeting of the minds there. I’m pretty sure he had no idea what I was talking about.
Kryptik
Because Insurance companies just can’t survive unless they’re free to drop even more of their customers at a whim. That pesky regulation thing just is such a burden on everyone, isn’t it?
amorphous is taking suggestions for a new handle
@Seebach: But this has NOTHING to do with the President’s race. NOT A DAMN THING. SHUT UP SHUT UP SHUT UP BECAUSE IT DOESN’T.
jwb
@Joshua Norton: airline deregulation has probably been more good than bad—though I don’t think it worked the way people thought it would.
PeakVT
Once you agree to cover everyone, what value do heavily regulated private insurance companies add over a government-run single payer system? None that I can see.
MBSS
@ john cole
i’m getting some wordpress error screens, then i refresh and it goes back to normal.
Church Lady
Why am I in moderation? I didn’t say any of the “ist” words that will thow a comment in there.
Martin
Yes, airline price deregulation in 1978. And this I think is the source of the whole ‘deregulate everything’ thinking.
Remember when it cost $600 (in 1978 dollars) to fly from LA to NY, and now it costs $49?
With that came a huge expansion of airlines and flights and a lot of market efficiencies – all good things. With that also came shitty customer service, a lack of funding for airport and traffic control system expansion and upgrades, and a lack of innovation in aircraft because nobody has the money to break out of the 747 approach model. Plus, most of the airlines are constantly on the brink of bankruptcy – all bad things. And it’s unlikely 9/11 could have happened as it did under a regulated air system.
But I would argue that from the standpoint of consumers that were of voting age in 1978, it’s been a good thing. The air traffic system won’t completely fall apart before they die, and it really has opened up air travel.
Now, there’s a HUGE difference between price regulation and market regulation, and with the exception of necessities like electricity, basic foodstuffs, and the like, price regulation *is* a bad idea. In its place should be broader market regulation. There has to be *some* regulation of some form or else the free market just consumes everything around it. The free marketeers can’t seem to recognize that markets don’t remain static. Take regulation out of insurance and they’ll expand out into financial areas and walk right up to extortion. The US/Mexico is a nice example of an effectively deregulated market (drugs) consuming all surrounding markets because the rewards for the drug market are so high relative to anything else that they’re willing to wreck anything to reap those rewards.
Other markets aren’t any different, but we’ve kept things in relative balance that we don’t see that. We’re getting a nice peek at it with the financial markets though – they certainly were willing to break laws and run the country into the ground for their bonuses. Insurance execs aren’t inherently more ethical and social leaning than financial execs. ‘Rational self-interest’ isn’t really possible when there’s such a massive disparity of social power between a citizen and a corporation (who we’ve determined have comparable rights).
Eliminate the notion of corporation, and you might actually be able to reduce regulation because the responsibility of company execs would increase substantially. A corporate bankruptcy would result in a personal bankruptcy for all of the officers. Nobody is willing to suggest that, however.
General Winfield Stuck
Such as the sun always rises in the east and sets in the west, it is just as dependable that when a republican talks about reform, he/she means more profits for some business, or another. It’s natural law.
Leelee for Obama
@Joshua Norton: The answer to your question is NO! They just keep digging in deeper, because the pony is obviously hiding under the pile of shit! These people who call themselves Republicans, Conservatives, Libertarians, or whatever simply want to pay nothing in taxes over and above Defense Spending, and minimal government. They want to live on Private roads, in Private Communities, and keep themselves healthy, or not, as they please.
Someone today said there was nowhere in the Constitution that mentioned a right to Health Care. I’d like to think the “pursuit of happiness” might work, but I’ll go with “promote the general welfare” as it’s more inclusive. Thoughts?
different church-lady
Did you just use the word “think” there?
Demo Woman
I’m listening to Steve Rottman of NJ hold a town hall meeting. He’s really informed, the questions are not soft paws at all and he’s handling them all.
feebog
@BFR: You could also make a case that deregulation of the Airline industry has been a complete and total flop. Major carriers have either gone out of business or been merged with other airlines. There are certainly fewer major carriers then there were before deregulation. Try flying to Hawaii, your choices are very limited. Same for Puerto Rico. Sure, there are some routes that are realtively cheap if you book in advance. But if you have to change your booking or book at the last minute, you are SOOL.
Hunter Gathers
@kay: “And, who oversees that reserves cover potential liability? Like, the SEC or something? That’s money in the bank.”
Perhaps the failure of the SEC had something to do with who was running the Executive Branch up until January.
That and Congress being owned by Wall Street. The reason nobody trusts the government to do anything right is because Dubya spent eight years trying to make governmental failure a feature, not a bug.
I have faith that the institutions in this country will work properly, as long as the people running said government institutions aren’t nihilistic jerkwads.
Demo Woman
Sorry, Rothman not Rottman. I’ve never heard of him but I’m duly impressed.
FormerSwingVoter
@kay:
This makes sense – that there are plenty of state regulations that won’t be redundant once reforms go through, even if a handful of them will.
To clarify my initial post, I’m against most forms of deregulation. But after all the talk of how much extra buying power a national public option would have and how it would bring down costs, I can’t help but wish there was a way to let the insurance companies trade over state lines without them going out of their way to screw everyone they see. I would think that would be a big enough concession to get some of the Blue Dogs and the Maine Repubs on-board with the public option. And, in theory at least, a private company could grow large enough, with customers in many states, to get some of those same savings the public option would.
Past experience with deregulation in basically every other field, though, would indicate that we would all just end up getting screwed. Big time.
different church-lady
1328285″>Martin:
Would today’s travelers accept limited regulation, $200 tickets, and better service?
Calouste
Because these people, mostly intentionally, confuse a unregulated market with a free market. If you want to have an example of why they are not the same, read up on John Rockefeller Sr. and the Standard Oil Trust.
jcricket
Of course you’re not wrong John. With the exception of Radley Balko’s stuff about crime, Libertarians are never right about anything.
They misdiagnose the problem, offer solutions proven not to work, ignore counter-evidence, wave away any arguments that aren’t addressed by their “elegant theory”.
We should take them as seriously as the “let’s just put them in a room and knock some heads” foreign policy experts.
We’ve seen enough evidence (30+ countries, 70+ years of system existence, millions of data points) to know that there are systems known to at least somewhat control costs while maintaining universal coverage and providing “best of breed” health outcomes. Those systems always involve heavy regulation and government involvement.
And there are systems that allow costs to spiral while limiting access and providing middling, at best, health outcomes. These systems do offer very high profits for private health-related industries. These systems always involve lax or little regulation and little government involvement.
The best a Libertarian has to offer a health care/insurance reform debate is to remind us to pay attention to slippery slopes or over-regulation killing innovation. Fine, we’ll grant them that’s a theoretical possibility and guard against it. Otherwise, it’s all typical hand-waving and esoteric theorizing.
different church-lady
OK, I officially miss the edit-after-posting function.
MBSS
Someone today said there was nowhere in the Constitution that mentioned a right to Health Care. I’d like to think the “pursuit of happiness” might work, but I’ll go with “promote the general welfare” as it’s more inclusive. Thoughts?
the constitution didn’t say anything about the internet either, but that doesn’t mean we should ban it. it’s a bullshit argument to me. “promote the general welfare” is right there, like you said. what do they think that means? price gauging?
it’s like the “states rights” argument. they use it to cover over all kinds of silliness.
“i’m not for roasting and eating babies myself, i just think it’s a states rights issue.”
Karen
Speaking as a 20 year insurance claims adjuster (retired) the only thing that keeps the companies in check is the fear of the state insurance commissioner. Take the companies nationwide & you take all the regulatory power from the states. No regulation has already shown itself to be disaster in the making. You’ll have an out-of-state company selling sub-standard coverage & denying claims, with nobody who has any authority over them. Bad news in the making.
I’ve already written to my local rep about it when Colorado was considering it.
amorphous is taking suggestions for a new handle
@different church-lady: Along these same lines, there is no way that my flight from Austin to Germany actually costs the airline only $350 (which is what I just got it for). Losing money is a bad business model, yet airlines seem to do it regularly.
Joshua Norton
Oh mah gawd! I broke WordPress again.
lamh31
OT: “A “Death To Obama” Sign At Cardin’s Town-Hall”
http://politics.theatlantic.com/2009/08/recess_watch_a_death_to_obama_sign_at_cardins_town-hall.php
jenniebee
You know, there really is a solution here. Deregulate insurance and dump Medicare.
Then, after the assholes crowding into townhall meetings to bitch about how we’re all going to be goosestepping if the government gives anybody else half as good a deal as it’s giving them have their fair free-market chance to die off at the hands of the private-insurance death panels the rest of us can have our calm, rational discussion about finally getting single-payer (and, of course, how to solve the recent coffin shortage.)
Fucking retirees on Social Security and Medicare asking why their non-existent tax dollars should pay for the uninsured… getting a little tired of their BS and ready to ask it right back at them.
lamh31
OT: “A “Death To Obama” Sign At Cardin’s Town-Hall”
http://politics.theatlantic.com/2009/08/recess_watch_a_death_to_obama_sign_at_cardins_town-hall.php
kay
@FormerSwingVoter:
But that hasn’t worked in states, right? Bigger is cheaper? One of the big revelations of this whole debate (to me anyway) is intra-state monopolies of insurers.
So how big do they have to be to realize savings? Obligatory, scary music…TOO BIG TO FAIL?
The key to the public option offering competition isn’t just “big” it’s “non-profit”. The public option has to cover costs and expenses. It doesn’t have to make a profit.
Mayken
I still write or call my congresscritter about health care reform (and other issues) even though he is a Republican (albeit on the moderate side.) I get the same answers every time regardless of my argument refuting the previous ones: tax breaks, deregulation and medical malpractice reform. These guys are just amazing. These things that have been proven wrong for decades so let’s double-down on them. *sigh*
Seebach
The enumeration in the Constitution, of certain rights, shall not be construed to deny or disparage others retained by the people.
That’s where it is in the constitution. I’m certainly glad they did eventually decide to put in a Bill of Rights, because at first they thought doing such a thing wasn’t necessary. Imagine where we’d be then.
MBSS
@feebog
Try flying to Hawaii, your choices are very limited.
aloha airlines just went out of business a couple years ago. i agree with you on that point.
kay
@Karen:
“Speaking as a 20 year insurance claims adjuster (retired) the only thing that keeps the companies in check is the fear of the state insurance commissioner.”
I agree and I think you should stick around for many, many questions.
Mark S.
@Leelee for Obama:
“Pursuit of happiness” is in the Declaration, not the Constitution. The Court used “general welfare” to uphold Social Security back in 1937.
Calouste
@Martin:
demimondian
@Seebach: Umm…yeah. I always love it when people cite the tenth amendment. Listen, puppy, remember the interstate commerce clause? Yeah, that’s the one which gives the Feds the power they want here. Given the number of national scope insurance companies involved, that should be obvious.
Oops. Sorry. You probably have trouble with obvious things. Never mind.
Zach
Eliminating state regulations and sticking with a national standard for health insurance and health care is a good idea; state inspectors are notoriously less rigorous than federal inspectors and decisions made by state inspectors (to shut down facilities, transfer patients, etc) are often manipulated by corrupt local governments.
It also eliminates the artificial market barriers between states (can’t have the same policy in different states, healthcare changes when moving between states with the same employer, etc) and insures that children won’t be born into a state with shitty health regulations (cf education) through no fault of their own.
It would insulate insurers from attacks by state governments, but, coupled with strong federal regulation, it’s a good idea.
I’m no gung ho freemarketeer; I’m all for a US NHS. Deregulating health care at the state level is a no-brainer, though.
Ash Can
@Church Lady: Dollars to donuts your comment went in moderation because of the lower-case “c” in your name. It appears the system is case-sensitive and recognizes a change in upper or lower case as a brand new poster, hence moderation for “church Lady.”
rumpole
No.
Just imagine–the insurance market is completely deregulated and then goldman sachs et al get to create derivatives based on the assumption that a bunch of people will never get sick at once. Call them flu-default-swaps. Then when it all blows up, we will have to intervene to save the health insurance market from collapsing.
Fucking brilliant.
I am now off to short whole foods.
Mayken
@aimai: Animaniacs reference ftw!
jcricket
The classic example I refer to when shutting up a Libertarian is that of stock markets. There are several really good studies showing that the more regulated a stock market, the higher the investment levels, and higher the profit for stock holders.
The fundamental reason is that people don’t invest in what they can’t trust. They can’t trust what isn’t transparent. And transparency and consistency are provided by regulations.
Basically Libertarianism is today’s Communism. Interesting sounding in theory, but demonstrably false from the core.
kay
@Zach:
You’re assuming that the federal regulations will be stronger than the state regulations and that’s a poor assumption.
amorphous is taking suggestions for a new handle
@Calouste: I think we both know the proper solution to this problem: tax cuts.
Seebach
Demimondian, we’re on the same side, I think. I just meant that because there was no “right to healthcare” listed, doesn’t mean it’s not in there. There is one whole amendment that says “just because it’s not listed, doesn’t mean it’s not in here”.
Bruce (formerly Steve S.)
Deregulation in health care insurance might indeed succeed in covering most people and would work about like deregulation in the airline industry, I would think. Rich people will fly when and where they want in relative comfort, the rest of us will ride coach. Insurance companies will evolve into two kinds; Virgin Atlantic Health Care and Jet Blue Health Care. Jet Blue will have more seats in the waiting room with about 8″ of legroom in front of you. Arm rests are $10 extra, People Magazine $15, People Magazine from the last five years $25. And so on.
kay
@Zach:
That isn’t really the proposal. What they’re saying is remove barriers, so you can purchase insurance in any state, and take it with you to any state.
The policy would still be governed by the state of issue, as yours is now, but John’s point is that state of issue would inevitably be the least-regulatory state, because they’d have 50 state regulatory schemes to choose from.
Ruckus
@Leelee for Obama: How about the right to life?
You’re right though, hard to pursue happiness in ill health and bankrupt.
SGEW
@Leelee for Obama:
This is accurate. Likewise, the Constitution does not mention any individual citizen’s “right” to postal service, primary education, paved roads, fire departments, police protection, or an Air Force.
Just because there isn’t an enumerated individual right to something in the Constitution does not mean that the Government isn’t constitutionally allowed to do something (except for the Air Force, which, under an Originalist interpretation, is frankly unconstitutional [1]), even if they are not obliged to do so. You don’t have a “right” to most government services, but the Federal gov’t is still allowed to provide them.
However, there are many people who really do believe that the government (Federal or state) shouldn’t be allowed to build roads or deliver our mail or whatever: their argument against any governmental health care program follows the same line of reasoning [2]. Luckily, most people rather like the idea of public roads, free education, and not-for-profit fire departments (“Save my baby!” “Sorry, ma’am, your insurance lists your baby as a ‘pre-existing condition.'”): health care just adds to the list.
[1] This is the cliched (yet still chuckle-worthy) argument for why Originalist interpretations are often full of shit.
[2] The argument is about the whether the Federal government itself has a “right” to provide the service (see, as one example, the Commerce Clause and attendant debate). Think Ron Paul, or Clarence Thomas.
kay
Remember this?
“Opening up the health insurance market to more vigorous nationwide competition, as we have done over the last decade in banking, would provide more choices of innovative products less burdened by the worst excesses of state-based regulation.”
John McCain
Indylib
@amorphous is taking suggestions for a new handle: They may have lost money on your flight to Germany, but they make up for it when they charge me the same amount, $350, to fly my stepson from Denver to Milwaukee.
arguingwithsignposts
I swear I’m going to have to stop following politics. Teh stupid, it burns!
@rumpole:
FTW!
Too sick to fail?
SGEW
[O! How I miss the edit function]
The Grand Panjandrum AKA Americans for America
You will have to explain what you mean by “deregulation” first. Currently, insurance is regulated solely at the state level. In other words, states decide how stringent or lax those regulations are. You must abide by that states laws or you can’t sell insurance. If you mean that the Federal government enact legislation that requires certain minimum standards, and states are free to enact stricter regulation–then, hell yes. If you mean that the Feds set maximum standards for regulation, or require states to recognize other states insurance laws–then, hell no.
You then need one state (I’m looking at your credit card laws South Dakota!) to set standards so low that it effectively makes it impossible for any other state to control these thieving bastards. Reagan pushed for the current Federal credit card law and the weak ass Democrats went along with him. That is why states with very strong consumer protection laws have their hands tied when it comes to a reigning in usurious credit card companies.
Sleeper
@Tony J: Exactly. Capitalism cannot fail. It can only BE failed by those insufficiently capitalist.
gex
@church Lady: Did you read any of the comments ahead of you? This kind of deregulation is an exact analogy to the credit card industry deregulation from decades ago. The one where all the credit card companies moved to South Dakota, which had virtually no rules on credit cards, and those regulations became the standard nation-wide.
You are the reason I piss off steve s.
Brick Oven Bill
Stop bitching SGEW. If you were a better writer, you would not need to edit.
Lawyers.
Jason
You know, I’m pretty sure they just want you to ask the question, not evaluate the answer. With this you get down to the nitty gritty: when you say “deregulation is your answer for everything,” they say “social programs are your answer for everything.”
The conservative political and economic viewpoint went straight to the conclusion that any reform bill would be socialist, and attacked from there. What’s the opposite of that? No regulation whatsoever. So, when somebody says, “Well that’s a crap idea,” they are objectively and on-the-record against the free market. And when somebody asks, “Why would that be so great? Corporations are greedy and bureaucratic and unresponsive” they say, “That’s just what we said about the gov’t, and you dismissed us as crazy. Well, who’s crazy now, sucka?”
I mean, once you disagree with “bomb Iran,” you’re more or less dispensing with any nuanced discussion, and whose interests does that help? The smartest way to paint yourself into a corner is to use the broadest brush you have.
AkaDad
Look at the mess the automotive industry is in. It all started when we forced manufacturers to provide seat belts and air-bags.
Church Lady
@Ash Can – You’re most likely right. I noticed after the post that I didn’t capitalize the “C” and corrected it for the second post. On the other hand, the second post, with the corrected name, also went into moderation. Ah, the mysteries of Balloon Juice.
Church Lady
@gex: My comment was in moderation so long that a lot of what wound up ahead of me wasn’t there yet.
Seebach
Michael Savage says internment camps are being set up for conservatives.
gex
@Calouste:
That’s the kind of deregulation the right and the libertarians can get behind! Tax the poor and give to the rich! Woot!
ruemara
Every so often, I look at my jamaican passport and contemplate abandoning this country to it’s abject stupid fate. This is one of those times. I can go anywhere this delightful little old lady with crown is respected, so why am I trying to educate teh morans on why blowing themselves up even effing more is a bad thing?
General Winfield Stuck
@Church Lady:
That’s not how it works. Your comment, when released remains in order from where it was originally posted.
E.D. Kain
Hunter @
You should read my post before you say silly things. Reading before making arguments is always a good idea.
Demo Woman @
When has deregulation actually led to more monopolization? Right now most communities are pretty much tied to one single health insurance provider. It really can’t get much worse.
General Winfield Stuck
testing
cleek
ruh roh… are the MySQL errors back ? i just a bunch of them on the right side bar.
Mayur
@E.D. Kain: When has deregulation actually led to more monopolization?
Broadband/ISP services and radio and television media, to mention the tip of an iceberg.
Don’t ask rhetorical questions to which people can provide simple answers, please.
Mayur
@E.D. Kain: When has deregulation actually led to more monopolization?
Broadband/ISP services and radio and television media, to mention the tip of the iceberg.
Don’t ask rhetorical questions to which people can provide simple answers, please. Or at least read Bagdikian’s Media Monopoly or Rowley et al’s The Political Economy of Rent-Seeking in order to understand what you’re contradicting in the first place.
arguingwithsignposts
@E.D. Kain:
Deregulation of the airline industry results in fewer carriers. Deregulation in the energy market led to Enron’s attempt to corner the electricity market in California. Deregulation in the broadcast industry led to clear channel and Rupert Murdoch’s evil empire. Deregulation of financial markets led to the shit-storm we are in right now and the consolidation of power among even fewer w.s. banks.
And “deregulation” isn’t just bad because of greater “monopolization” (although I’d argue it’s not so much monopolization as the consolidation of power among a small group of corporations).
The lack of regulation gave us child labor, dangerous work environments, unsafe food, rampant pollution from factories, and cars with no safety apparatus (like, y’know, seatbelts).
Generally speaking, when someone talks about “deregulation,” what they actually mean is “I have figured out a way to screw over the consumer, if not for these pesky gov’t regulations.”
JM
Right now most communities are pretty much tied to one single health insurance provider. It really can’t get much worse.
Right now, 94% of the US lacks health insurance competition, according to the AMA.
It’s already at its worst, which is why we need the public option.
JM
Deregulation is a front for fraud.
tamiedjr
I also got some more sql errors on the right hand bar, but they went away again.
kth
No need to flame that guy, their blog is actually very nice as conservatives go. And the idea isn’t blanket deregulation (because he favors some regulation), but a level playing field across state lines so that consumers have more choices. Right now consumers in most markets have very few choices.
Principle applies to financial institutions as well: it would be better to introduce robust federal regulation, than to go back to the patchwork of state-by-state standards. There are advantages to allowing financial institutions (including insurance companies) to operate across state lines–as long as laissez-faire states aren’t allowed to impose their low standards on the rest of the country.
In short: federalism is ridiculously overvalued in our politics, and that goes for state regulation of industry as much as it does state regulation of unions, administration of schools, dispensation of welfare, running elections, and the rest.
Martin
Oh, I should add that the proper response to this proposal is to scream “States Rights!” at the top of your lungs any time anyone comes close to suggesting it.
kay
@E.D. Kain:
I think it could get much worse. Any state could offer a completely loose regulatory scheme, and thats where insurers are going to go.
An insurer could locate in that state and market the policy nation-wide, but it would be governed by the originating state scheme, so unregulated, with the exception of any federal regulations that apply.
One of the wonderful surprises with health insurance is you don’t find out your policy is garbage until you need it.
The federal scheme overlaying the originating state scheme would have to be comprehensive to protect consumers and make this work, and then we’re sort of back to square one, right? Where we’re hoping for economies of scale?
Zach
@kay: In his post, E.D. Kain’s bullet point is, “Deregulation of insurers to allow national competition: with proper rules in place, more competition will only help consumers.” I’m saying that this is very reasonable given the current toothless state of insurance regulation in much of the country. It’s not really analogous to what happened with the financial industry (incorporating in DE) because we’re talking about zero state regulation, not cherry picking a state with little regulation to conduct business in.
Demo Woman
@E.D. Kain: Thanks Ed for responding. There are a few concerns that I have, one the lack of safe guards to prevent larger companies from buying out smaller ones. Secondly, the financial health of companies so they don’t need bail out money. What are the safeguards that prevent a few companies from price fixing. Right now physicians are paid for each service and unless they control that cost, prices will remain high. I have $1000 deductible so a recent blood test cost $260.00 out of pocket.
I live in GA and they privatized the natural gas industry to increase competition, yadda, yadda, yadda. When all the companies offer the same rate, that didn’t really increase competition. Our bill now has a fee from Atlanta Gas for providing the equipment, and from the provider of the gas. Believe me prices did not go down.
Seebach
There really is no such thing as “deregulation”. There’s only re-regulation into a different system. That’s why it’s more important to ask exactly what they are talking about.
steve s
“You are the reason I piss off steve s.”
Oh I’m not pissed off in the least. I’m just worried that ridiculous overuse of the label is leading to sprained inferior rectus muscles from people rolling their eyes so hard. Optometrists report that 73% of patients with that injury recently read Balloon Juiceº.
You might even say I’m concerned…
º: (The other 27% were caused by Steve Benen injecting “…wait for it…” in arbitrary sentences. Which he seems to have actually stopped doing a few months ago after enough of his regulars started mocking him in the comments. You’d be amazed at how many otherwise intelligent people think a joke is still funny the 687th time.)
kay
@kth:
But the regulations that make insurance more expensive state to state are what would be “leveled”, and those regulations mandate more coverage, not less.
It would necessarily be less regulated, and that’s where the competition comes in.
It doesn’t work unless you race to the bottom.
I actually think states aren’t going to go for it, because they are going to be stuck holding the bag when the cheaper policy doesn’t cover expenses of their resident “insured”. The purchaser is in their state. The person who ends up underinsured is going to go to the residence state emergency room, not one in the unregulated state that issued the policy.
Silver
Michael Savage says internment camps are being set up for conservatives.
Obama always does everything half assed. A real liberal would be setting up death camps for conservatives.
Maus
“My question- why does everyone think this will be such a great thing?”
Because “truly free market” conservatives and randroids live life by “fuck you, i’ve got mine”, even if they don’t have theirs?
They would rather see everyone suffer than see one person be protected from corporatism.
Tax Analyst
The GOP solution to EVERYTHING:
Step 1: Deregulate/Cut Taxes/Rinse/Repeat
Step 2: When this results in a total clusterfuck blame it on the ‘lieb’rals’.
Step 3: Make sure things are so fucked up that corrective action will be extremely expensive.
Step 4: Decry attempts to take corrective action because, “We can’t afford it” “Those Democrats, all they want to do is ‘Tax and Spend, Tax and Spend’.
Step 5: Make sure all your water-carrying thugs get thorough instructions from the usual noise-machine sources (Limbaugh, Hannity, Malkin, etc).
SGEW
I nominate this sentence as the least convincing argument in a comment thread full of cynics.
E.D. Kain
Actually the example of Broadband/ISP is ludicrously bad. Maybe if we’d just kept AT & T as the only provider of telecom services we’d have a better system – is that the general idea? I sincerely doubt it. In my home town we only have two providers of high-speed internet, but I’m sure glad we have two rather than just one. In places with more providers, cost is generally a little bit lower, but speeds are much higher.
And the airline industry is even worse. Flights have gotten far, far cheaper since airlines were deregulated. Imagine the same regulations, coupled with the tight security and costs, and increases in fuel costs – prices would be through the roof.
And don’t even get me started on beer deregulation. One of the best things Carter ever did.
Look, I don’t oppose regulations that prevent abuse – national regulations, too. Let’s end rescission and let’s get rid of the whole notion of pre-existing conditions. In my post I advocate for mandates and new regulations as well. I just also think we could bring more competition into the mix to increase cost-effectiveness and prevent monopoly. I also advocate vouchers for this same reason.
See the Dutch model for a system that is far more free-market than ours, and is very similar to what I’m proposing. They have universal coverage, but they do it with competition as one of the key components.
Sly
The deregulation argument always struck me as odd.
In New York, we have one market that is lightly concentrated (relatively speaking… lightly concentrated insurance markets are dominated by 4 or 5 corporations instead of just 1 or 2). NYC. But if you go to Long Island, it’s much more concentrated. Go to Rochester, and Excellus has almost 60% of the market. In Ithaca, Empire BCBS holds 75% of the market.
There are some states where the level of concentration is uniform (and almost always super high), but there are just as many states where the level isn’t uniform. So the notion that just allowing insurance companies to compete across state lines (with the caveat that they would still not be subject to Federal Anti-Trust statutes, of course) has always come across to me as snake oil.
E.D. Kain
And can I just urge commenters to read my damn post before responding to it? If only because I’m tired of reading these comments about “the only thing conservatives and randroids etc. etc.” since that’s not at all what I say.
This whole demonization/generalization game is annoying no matter which side does it.
JM
Actually the example of Broadband/ISP is ludicrously bad. Maybe if we’d just kept AT & T as the only provider of telecom services we’d have a better system – is that the general idea?
No.
E.D. Kain
SGEW – of course it could get worse. I’m simply saying that the current system is pretty horrible and anti-competitive. Any conservative who argues for the current system is sacrificing principle for partisanship.
kay
@E.D. Kain:
But why would it be cheaper? You’re saying you will set up a robust national regulatory scheme to replace the state schemes, and that’s where the competition comes in.
But policies are cheaper state to state not because of “patchwork” regulation, but because of variances in regulation. More regulation, more they have to cover, more expensive.
If you’re just going to replace a robust scheme with a robust scheme, where are the savings? Where does the competition come in?
I think this only works as a competition mechanism or a cost-saving mechanism IF it’s a race to the bottom.
MBSS
E.D. Kain. i disagree with you, but commend your reasonable approach to debate.
charter has a monopoly on cable on the central coast of cal. they rape us on prices. they have a 3-in-1 package (telephone, cable, and internet) that gives you no savings compared to buying piecemeal. thanks charter.
Svensker
I can sort of see where the “deregulate the states” folks are coming from. We live in NJ and are self-employed. When we started out we had a major medical policy with a modest deductible and a modest premium. Then, in order to “protect” its NJ workers, the state outlawed major medical policies and said everyone had to have full insurance. We went from paying about $6K a year for insurance to about $10K thanks to their “protection”. They put in all kinds of other limitations on companies, as well, such that my SIL, who lives in NY and wanted to move to NJ, didn’t, because she wouldn’t be able to get her NY coverage in restrictive NJ and she needs her insurance because her hub has major health issues.
So, yes, deregulating NJ insurance would help us.
However, I think government run insurance would help even more at this point.
Calouste
@kth:
What do you mean with that? The only choice most Americans have is go with their employer’s health insurance plan or pay a lot more on the private market, if they can even find an insurance company that will accept them. The scam perpetrated by the opponents of the public option is to pretend that people have a choice at the moment, where in reality most people don’t have any choice.
Evinfuilt
Meanwhile Ron Paul is out to deregulate Pharma even more, I mean why require them to test and prove medicine works. He wants to legalize fraud, is that what Libertarianism has turned to?
http://scienceblogs.com/insolence/2009/08/ron_paul_quackery_enabler_part_ii.php
kay
@E.D. Kain:
In a sense, all you’re saying is if health insurance companies are allowed to get really big, national-big, cost will come down. But we know that’s not true. They’re really big now, and costs go up 30% a year.
I think this is the automobile insurance model, yet again. In my state, I can comply with state law with an automobile policy that maxs at 20k. It’s cheap, and it covers the state’s potential cost. That’s why they make us buy it. That won’t work for health insurance.
I’ve never made a claim on my current auto policy. Never. It’s been years.
JM
See the Dutch model for a system that is far more free-market than ours
Really?
A key feature of the Dutch system is that premiums are set at a flat rate for all purchasers regardless of health status or age. Risk variances between funds due to the different risks presented by individual policy holders are compensated through risk equalization and a common risk pool which makes it more attractive for insurers to attract risky clients. Funding for all short term health care is 50% from employers, and 45 percent from the insured person and 5% by the government. Children until age 18 are covered for free.
Good luck selling this as “free market” in the USA.
arguingwithsignposts
@E.D. Kain:
I’m operating from the assumption that you’re arguing in good faith here, so I’m going to propose something that genuinely *would* benefit the marketplace through greater competition: the ability of small employers to get together to bargain for lower premiums.
Example: I used to work for a small private college. Because this college was so small, it could not bargain with health insurers for lower rates. A single individual on that campus who developed cancer would jack up rates for the entire pool. As a result of this lack of bargaining power, most employees actually glommed onto their spouse’s insurance, which was provided through a school district or state gov’t entity, thus diluting the pool even further.
If this college had been able to band together with other small colleges to form a larger pool, rates would have gone down and everyone (except the insurers) would have been happier.
Allow small employers to pool together (even individuals to join in a large pool) and you’d serve the same purpose. drive costs down by widening the risk pool.
That sounds awfully “co-op” like, doesn’t it? Too bad the health insurers didn’t try something like this before, they’d not be facing the rewriting of their entire economic model.
Personally, I’m single-payer, but I’ll take a strong public option. Anything else and I’m not voting for anyone who signs on. Period. I’m tired of being constrained by employment as to whether I can have quality health insurance or not, and feeling like a tenant farmer just to keep my family healthy. America is BETTER than this bullshit. I wish we’d act like it. /rant
And, btw, if you’re not actually proposing “deregulation,” don’t use that term. What you seem to be proposing is “different regulation,” which is an entirely different thing altogether.
E.D. Kain
kay –
They’re really big now, and costs go up 30% a year.
They’re big but they’re also not forced to actually compete with one another. That’s a pretty fundamental flaw in how any industry ought to do business. When there’s only one game in town, it’s no surprise when costs go up.
Mayur
E.D. Kain: @E.D. Kain: Independent ISPs and broadband service providers did a great deal of writing on how competition was destroyed and monopolies (ILECs) protected by dereg. You, OTOH, provide the following (IMO pretty absurd) strawman argument:
Maybe if we’d just kept AT & T as the only provider of telecom services we’d have a better system – is that the general idea? I sincerely doubt it. In my home town we only have two providers of high-speed internet, but I’m sure glad we have two rather than just one.
You’re reaching back to the eighties and early nineties: the era of the fricking telephone. I’m talking about the early 2000s here, which is the era actually relevant to broadband/ISP deregulation. The deregulation at issue is the numerous exemptions provided to ILECs and RBOCs from the 1996 Telecom act.
Yes, deregulation of telecoms was a good idea. Also yes, further deregulation and exemption of ISPs and ILECs led to monopolization.
I’m not trying to flame you here, just point out that your little flip comment is completely incorrect.
Evinfuilt
To all of the people pointing to Airline deregulation as a good thing, I do wonder one thing. How would the airlines of old handled this past decade? I mean the government has had to bailout airlines constantly for over a decade. To me deregulation is just the first step to Privatize Profit, Socialize Risk.
arguingwithsignposts
Re: airline deregulation – I’m sick of the $15/$25 fees for “additional baggage” that I’ve been paying. Isn’t that what the damned cargo bay is for? Instead, I have other passengers bringing their large-ass suitcases up to the check-in counter and getting a tag so they don’t have to pay the damned fee. WTF, airlines? BTW, I noticed that oil prices went down but you didn’t take away those fees. Free market, bitchez.
kay
@E.D. Kain:
I just think you’re forgetting WHY policies might be cheaper. More of them, you hope, and cheaper. They’d be cheaper because (and only) because they’d be offered in a less regulatory environment, unless you’re talking about the small economizing that one regulatory scheme instead of 50 provides.
You’re hoping they’ll spring up and start competing, with your national scheme. But what if we just get 3 huge companies?
The people who are advocating having the less regulatory state issue a policy in ANY state are looking for savings. Not from competition, necessarily, but from a lesser product for some buyers. I don’t think that model works for healthcare.
E.D. Kain
Government should get out of the business of bailing out whatever industry – whether it’s airlines or banking. That’s simply protectionism at its worst. If an airline can’t hack it they should fail. If people still want to fly, some other airline will provide them with that capacity. Similarly, poor regulations that prevent entry into the market are protections for status quo players. Smart regulations are hard to implement, but one major thing to look for are regulations that actually lead to barrier to entry.
At the heart of many, many well-meaning or seemingly well meaning regulations is a special interest group that will benefit. Wal*Mart, for instance, will benefit from an employer mandate to provide health insurance. They also benefit from regulations that make it hard to sell used clothing or used toys.
Anne Laurie
Efficient targeting of “contributors” is a market good. Having only one or a very few legislatures to pay off (for the new insurance monopolies), or a single insurance monopoly to shill (for the glibertarians) would be considered a benefit by those proposing these deeply dishonest changes.
The boundaries of “promoting the general welfare” have, quite sensibly, expanded as our understanding of the interconnectedness of public-health efforts improved. When the Constitution was ratified, that meant taxes to provide clean water, set up some kind of animal control, and incentivize medical care and nursing facilities in every community large enough to be named. As our personal amenities have increased, so have the calls on the public purse — and the average life expectancy has increased from the mid-40s to the mid-70s. This would have to be considered a Net Positive to those of us not blinded by religious objections to any form of ‘collectivism’.
There’s always the Mencken question: Where else in the world could you find such a limitless source of cheap entertainment?
E.D. Kain
I’m all for people or organizations or small businesses banding together to purchase insurance and lower premiums through collective bargaining or by forming co-ops, etc.
kay – three big insurers would be fine if they were competing across the country. That’s better than one big insurer in one town and one other big insurer in another town not competing. So long as we don’t bailout insurers that do a crappy job we should be okay.
Sloth
@E.D. Kain:
E.D., I think your basic suite of reforms could work. Ending recission, pre-existing conditions and lifetime caps force the insurance companies to – you know – insure. More to the point, it aligns the incentives. Private insurance companies are, of course, in business to make a profit. Good for them – but the easiest way they have to make a profit is not to drive real reform through the rest of the stack (or even to reform themselves by reducing admin costs) it is through recission, not insuring, and by upping cost. Take those options away from them, and they are working for what we all agree is a good thing – driving down costs.
I still question whether the industry would naturally evolve into a competitive one. There may be a natural monopoly, in which case we’d still need to regulate – just as we did in other competitive markets (see: IBM, Microsoft, Standard Oil.) But we could maybe wait.
This could all work without a public option, but I think a public option is a quicker way to do it. I think it very likely that a public option could drive costs down quicker than the private guys will be able to.
But I would be OK without it, with the above requirements in place.
I would add that it absolutely frosts me that this industry is not today providing a competitive (with other countries) product. They have a MASSIVE advantage – the U.S. taxpayers are, today, doing all the heavy lifting for them. We insure the most risk-prone portion of the population.
Zach
@JM: It was sort of hilarious to see a gang of some number or other of Republicans endorse the Swiss model of health care for its free market values… that caps individual contributions at 10% of income. I don’t think anyone ran the numbers to figure out just how much we’d have to dole out in subsidies to make that possible. I looked at it once and it turned out it’d double our federal health expenditure or something like that.
kay
@E.D. Kain:
I think it would be a disaster, E.D. I think your way would not offer savings or competition, so I’m not clear on what the point would be, and the GOP plan would offer savings, but mostly for insurance companies. Not for policy holders (who need more than a cheap product, they need a sufficient product) or taxpayers, who would end up picking up the under-insured costs in the end.
I think the GOP plan is yet more socializing risk and privatizing gain. I don’t want to do that anymore.
Nice talking with you, though, sincerely.
arguingwithsignposts
@Sloth:
not only do we insure them, we pay their bills when they can’t cover the charges for their ER visits. The repubs are right that this isn’t a “health care” issue per se – everyone can get health care if they go down to the ER (I worked at one, so I know). But that is nowhere near the most efficient way to dispense health care. And we ALL PAY one way or the other. I’d rather pay for a more efficient system.
slippytoad
Health insurance is regulated?
You fuckin’ coulda fooled ME. Right now trying to figure out how to get my fiancee onto my health plan without them fucking her over on the fact that she’s a diabetic. Wishing death and eternal damnation to all health insurance companies and their whiny baby CEO’s.
Tax Analyst
kay said (Re: meeting with Congressional Rep)
“Anyway, no meeting of the minds there. I’m pretty sure he had no idea what I was talking about.”
He was probably confused that you weren’t talking real loud in slogan-speak.
A “meeting of the minds” would require 2 functioning minds being present. I think your attempt was probably one short.
slippytoad
@arguingwithsignposts: BTW, you may be able to get emergency care at the ER, but can you get your blood pressure meds or diabetic meds there? Every day?
Signs point to no.
The Moar You Know
@Church Lady: For once, I hope he’s right.
Demo Woman
@kay: You’re right.
There does need to be a discussion of risk pools and what they would look like.
arguingwithsignposts
@slippytoad:
Most of the people I saw come through were at the point that regular checkups weren’t the issue. they couldn’t afford the drs. visits, so they waited until it was so bad that they had to go to the ER. That’s a calculation, and it’s a sad one that we allow in the U.S. God, I hate the republicans!
Tonal Crow
@Bruce (formerly Steve S.):
No. Airline “deregulation” (meaning, more specifically, no price regulation, little quality regulation, but very significant safety regulation) works because we and the airlines have roughly similar bargaining power. Most of us don’t have to buy an airline ticket, and when we do, we know pretty much what to expect, because the transaction is simple: I pay, the airline flies me to a known place at a known time. Healthcare is nothing like this. It is our health, and often our lives, that are at stake, so the insurers have us over a barrel. Further, the transactions are anything but simple, and we often have to conduct them while distracted by the illness that we’re trying to remedy.
Markets are a great way of allocating resources among willing participants who know what’s being offered, and who aren’t desperate to buy or sell. Markets are a piss-poor way of allocating resources when any of those provisos aren’t met.
Demo Woman
@Tonal Crow: A friend mentioned that the health care system just needs some tweeking. Neither she nor her husband could buy health care on the open market because of preexisting conditions and fortunately they won’t have to since he is a retired exec. She asked if I thought that was a better approach and I said “only if you make them non profit”. She choked on the other end.
I just don’t see deregulation helping, because they do have us over a barrel. I see it more like the natural gas companies in GA being allowed to set prices once the state privatized the industry. Let me tell you prices did not go down.
The last time the republicans were involved with health care we got primary care physicians whose pay depends on ordering tests.
Tonal Crow
@Demo Woman:
So she’s getting continuation coverage via her husband’s group policy? That’s called COBRA, and is mandated by federal law. Does she think she’d get that on in a deregulated market?
kay
@Demo Woman:
I feel as if people still don’t get it. I feel as if health care is going to have to take one of every two dollars people take home before they stop believing this problem will fix itself, with less regulation, or more regulation, or tax cuts, or one or another painless remedy. “Costs will come down, with no investment! Coverage will go UP!” In what world.
Other places address this. They look at it hard, and address it, and they keep working until they reach some reasonable accommodation between quality and cost, between shared risk and shared gain. We just won’t do it. We don’t want to. We’re still, after all these years, looking for an easy and cost-free solution, and it just ain’t gonna happen.
I think it takes a crisis, but it obviously has to be bigger than the financial crisis, because we learned not one thing from that. A lot of people have to go without care, or go bankrupt. A LOT.
Tonal Crow
@arguingwithsignposts:
I must differ. You can get your broken arm set at the ER. You can get care, until you’re stabilized, for your heart attack or stroke. But you can’t get diabetes treatment at the ER unless you’re in (or on the edge of) diabetic shock, ‘cuz progressive (but not acute) diabetes it not an emergency. Similarly, you can’t get treatment for your breast cancer there unless you are hammering on death’s door. And you can’t get your Lipitor prescription filled there, because that’s not an emergency (you’ve got to wait for the heart attack that it could have prevented).
Agreed.
Tonal Crow
[This didn’t appear the first time. Let’s try again.]
@arguingwithsignposts:
I must differ. You can get your broken arm set at the ER. You can get care, until you’re stabilized, for your heart attack or stroke. But you can’t get diabetes treatment at the ER unless you’re in (or on the edge of) diabetic shock, ‘cuz progressive (but not acute) diabetes it not an emergency. Similarly, you can’t get treatment for your breast cancer there unless you are hammering on death’s door. And you can’t get your Lipitor prescription filled there, because that’s not an emergency (you’ve got to wait for the heart attack that it could have prevented).
Agreed.
ksmiami
Take a breath and repeat after me: The right has no answers to the complexity of modern American life. There, rinse and repeat and then tune them out – their ideas have been around the merry go round time and again and nothing ever works.
Bruce (formerly Steve S.)
Hello, Tonal Crow. My comments were meant to be on the lighthearted side. But thanks for noticing.
Teresa
I am in 100% agreement with you.
Jason
I think the Republicans are right that this isn’t a health care issue per se – it’s every issue but health care. Watching Specter’s and Dahlkemper’s town halls, there’s nothing really being discussed about health care. It’s about totalitarianism and enfeebled political discourse and angry people who found themselves with a mic. That one guy at Specter’s town hall? He was so worked up he was nearly crying! That’s got nothing to do with health care.
Everybody’s saying “oh the Dems and Obama have lost the narrative on health care” – what narrative? What is anybody actually talking about? This, from the Genuinely Like-able Ed Kain:
Just stop there, right? Because that’s a sentence that isn’t designed to mean anything, but just sound like plain sense. Government (not just ours, but any, ideally, I suppose?) should get out of the business of fill in the blank. It’s no business for gov’t, this fill in the blank. It’s like gov’t rolled up its sleeves and said “hey let’s get in the business of whatever is the kids are doing these days.” Why not? Gov’t is full of businessmen and lawyers. When the deficit is high, we get candidates with all this “oh I ran a business this is no way to run a business I can run the gov’t like a business” shtick. Pennsylvania’s laying off hundreds of people – sounds like a business to me! Are you saying gov’t should eschew the business of something or other? Maybe be outright hostile to entrepreneurs, or go beyond that and just feign ignorance. “Lim…limited…li…liabilit…oh fuck it just raise the taxes.”
I’d be curious to hear an example of protectionism at its best. Protectionism at its worst, sounds bad! Protectionism really went too far this time. And now it’s gonna pay. How do you live with so many necessary evils?
Yeah the place is lousy with airlines and carmakers and radio stations and telecommunications conglomerates. I myself have a huge rubber band and a Y-shaped tree. Flights starting at 399.99, one-way only.
What is this idea that corporations are like some Leviathan that just catches pneumonia and dies because it’s evolutionarily inferior? And toodle-oo, never takes anybody with it. Funny how the economics of scarcity works for CEOs and top-flight athletes but for the working poor, not so much. Because if these compensation packets don’t go up, we won’t attract the best talent. No I think our maid services are adequate, that wasn’t what I was talking about.
It’s so odd, it’s almost as if you’ve got progressive politics. And yet you seem to be arguing against them. So I’m left to wonder on this, like so many other aspects of this debate, what the hell is really being discussed? Because it sounds like something, and that something is less the point than the fact that there is sound, period.
hads
No.
Of Bugs and Books
@Karen: Thank you Karen (#75)! More insurance “insiders”, more Wendell Potters please! Their critiques should deserve 10X the weight to people who haven’t figured out that there is a problem.
JR
If you believe the market is inherently rational and an adequate reflection of a society’s needs and desires, then de-regulation makes sense in this context. Also, you likely enjoy sniffing glue.