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Bust the Health Care Trusts


Jamie_B

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http://www.nytimes.com/2010/02/24/opinion/24reich.html?ref=todayspaper

[quote]Bust the Health Care Trusts

MY health insurer here in California is Anthem Blue Cross. So far, my group policy hasn’t been affected by Anthem’s planned rate increase of as much as 39 percent for its customers with individual policies — but the trend worries me, as it should everyone. Rates are soaring all over the country. Insurers have been seeking to raise premiums 24 percent in Connecticut, 23 percent in Maine, 20 percent in Oregon and a wallet-popping 56 percent in Michigan. How can insurers raise prices as much as they want without fear of losing customers?

Astonishingly, the health insurance industry is exempt from federal antitrust laws, which is why a handful of insurers have become so dominant in their markets that their customers simply have nowhere else to go. But that protection could soon end: President Obama on Tuesday announced his support of a House bill that would repeal health insurers’ antitrust exemption, and Speaker Nancy Pelosi signaled that she would put it toward an immediate vote.

This is promising news. Forcing insurers to compete for our business would do at least as much good as the president’s proposal to give the federal government, working with the states, the power to deny or roll back excessive premiums. The fact is that half of the states already have the power to approve rates and they don’t seem to be holding insurers back much.

Health insurers like Anthem claim they have to raise rates (as well as co-payments and deductibles) because of the economic downturn. Employers are reducing coverage and cutting payrolls. As a result, more people are buying individual policies, but they tend to be older and sicker. Younger and healthier Americans are simply going without insurance, and thus not subsidizing their costlier fellow policy-holders.

This can’t be the whole story, because big health insurers are making boatloads of money. America’s five largest health insurers made a total profit of $12.2 billion last year; that was 56 percent higher than in 2008, according to a report from Health Care for America Now.

It’s not as if health insurers have been inventing jazzy software or making jet airplanes. Basically, they just collect money from employers and individuals and give the money to providers. In most markets, consumers wouldn’t pay this much for so little. We’d find a competitor that charged less and delivered more. What’s stopping us? Not enough choice.

More than 90 percent of insurance markets in more than 300 metropolitan areas are “highly concentrated,” as defined by the Federal Trade Commission, according to the American Medical Association. A 2008 survey by the Government Accountability Office found the five largest providers of small group insurance controlled 75 percent or more of the market in 34 states, and 90 percent or more in 23 of those states, a significant increase in concentration since the G.A.O.’s 2002 survey.

Anthem’s parent is WellPoint, one of the largest publicly traded health insurers in America, which runs Blue Cross and Blue Shield plans in 14 states and Unicare plans in several others. WellPoint, through Anthem, is the largest for-profit health insurer here in California, as it is in Maine, where it controls 78 percent of the market. In Missouri, WellPoint owns 68 percent of the market; in its home state, Indiana, 60 percent. With 35 million customers, WellPoint counts one out of every nine Americans as a member of one of its plans.

Antitrust laws are supposed to prevent this kind of market power. So why are giant health insurers like WellPoint exempt? Chalk it up to an anomaly that began seven decades ago in the quaint old world of regional, nonprofit Blues. They were created in part by hospitals to spread the costs of expensive new equipment and facilities over many policy holders. Collaboration was the point, not competition. The 1945 McCarran-Ferguson Act made it official, exempting insurers from antitrust scrutiny and giving states the power to regulate them, although not necessarily any power to regulate rates.

The system worked fairly well until about two decades ago when insurers began morphing into publicly held, for-profit cash machines. A new breed of medical entrepreneur saw opportunities to profit from a rapidly aging population eager to get every new drug and technology that might extend their lives, and a government committed to doling out hundreds of billions of dollars in Medicare and Medicaid.

With size has come not only market power but political clout. Big for-profit insurers deploy enough campaign money and lobbyists to get their way with state legislators and insurance commissioners. A proposal last year to allow California’s Department of Insurance to regulate rates, for example, died in committee. These companies have even been known to press states to limit how many other health insurers they license.

And when they can’t get their way, insurers go to court. In Maine — one state that aggressively regulates rates — WellPoint’s Anthem subsidiary has sued the insurance superintendent for reducing its requested rate increase.

Political clout can be especially advantageous at the federal level, as the big Wall Street banks have so brazenly demonstrated. Over the past two and a half years, WellPoint’s employees and associates have contributed more than $922,000 to federal political campaigns, and the company has spent $7.8 million lobbying Washington policymakers, according to the Center for Responsive Politics. It should not be surprising that WellPoint was one of the leading opponents of the public insurance option, which would have subjected it to competition even where it had sewn up the market.

Antitrust is no substitute for broader health care reform, but it’s an important prerequisite. If a handful of giant health insurers are allowed to dominate the industry, many of the other aspects of reform (establishing insurance exchanges, requiring people to have insurance, even allowing consumers to buy insurance across state lines) won’t bring down the price of insurance.

Regardless of what happens at the White House’s health care meeting on Thursday, we’ve got to make sure health insurers compete for every one of our dollars. First chance I get I’m going to find another health insurer here in California — unless Anthem has such a lock on the market I can’t find a better deal.

Robert B. Reich, a professor of public policy at the University of California, Berkeley, and a secretary of labor under President Bill Clinton, is the author of “Supercapitalism.”[/quote]
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[i]The system worked fairly well until about two decades ago when insurers began morphing into publicly held, for-profit cash machines. A new breed of medical entrepreneur saw opportunities to profit from a rapidly aging population eager to get every new drug and technology that might extend their lives, and a government committed to doling out hundreds of billions of dollars in Medicare and Medicaid.

With size has come not only market power but political clout. Big for-profit insurers deploy enough campaign money and lobbyists to get their way

[/i]-All you need to know as to why the current system will never go away. To many people make way to much money for them to ever want to give it up and they'll do what they need to do to keep it the way it is.

-Everyone is to corrupt and fuckin' greedy to make any kind of actual difference for you and I everyday citizen.
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[quote name='Jamie_B' date='24 February 2010 - 08:55 PM' timestamp='1267062921' post='865214']
and here I thought the market worked

:ninja:
[/quote]


It does if you remove barriers to competition. Allowing consumers to buy health insurance from other states would be a good start. Tort reform would be another good step.

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[quote name='John~Galt' date='25 February 2010 - 10:42 PM' timestamp='1267155767' post='865499']
It does if you remove barriers to competition. Allowing consumers to buy health insurance from other states would be a good start. Tort reform would be another good step.
[/quote]
Actually, it never has in the sense meant by free market or libertarian ideologists. A quick survey of economic history (including recent) demonstrates that, quite the contrary, the impulse is almost always anti-competitive and tends towards cartel and monopoly. That's why one finds a lot of law (be it related to constitutional, positive or contract) is dedicated to ensuring that there is at least some form of competitive market place [i]as a result[/i] of legislation, usually related to ensuring a somewhat level playing ground.

What rational free market ideologists get confused about tends to be their related to definitins of freedom and liberty. And then of course there are the anti-authority misfits who just have never grown up emotionally into a fruitful adulthood, who often tend to find their way into the free market camp, but that's another story altogether.
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[quote name='Homer_Rice' date='26 February 2010 - 07:19 AM' timestamp='1267186778' post='865519']
Actually, it never has in the sense meant by free market or libertarian ideologists. A quick survey of economic history (including recent) demonstrates that, quite the contrary, the impulse is almost always anti-competitive and tends towards cartel and monopoly. That's why one finds a lot of law (be it related to constitutional, positive or contract) is dedicated to ensuring that there is at least some form of competitive market place [i]as a result[/i] of legislation, usually related to ensuring a somewhat level playing ground.

What rational free market ideologists get confused about tends to be their related to definitins of freedom and liberty. And then of course there are the anti-authority misfits who just have never grown up emotionally into a fruitful adulthood, who often tend to find their way into the free market camp, but that's another story altogether.
[/quote]


This
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[quote name='Jamie_B' date='26 February 2010 - 07:31 AM' timestamp='1267187478' post='865524']
This
[/quote]

So that explains why you're blaming the failure in health care on the free market?

Can you tell me what about of our current health care system even comes close to resembling a free market?
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[quote name='JohnnyUtah' date='26 February 2010 - 08:17 AM' timestamp='1267190232' post='865540']
So that explains why you're blaming the failure in health care on the free market?

Can you tell me what about of our current health care system even comes close to resembling a free market?
[/quote]


It doesnt.

Care to tell me how it got that way?
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[quote name='JohnnyUtah' date='26 February 2010 - 08:17 AM' timestamp='1267190232' post='865540']
So that explains why you're blaming the failure in health care on the free market?

Can you tell me what about of our current health care system even comes close to resembling a free market?
[/quote]

That's the point on a lot of these issues. People are spouting off about how the free market failed. The fact is the free market has never been given a chance. Government interference has fundamentally changed these markets. We call our markets free but they have not been free since around the time the constitution was ratified.

The really sad thing is that you have individuals that have been so programmed by the nanny state that they actually argue AGAINST their own freedoms. :suicide_fool-edit:

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[quote name='John~Galt' date='26 February 2010 - 11:45 AM' timestamp='1267202720' post='865599']
That's the point on a lot of these issues. People are spouting off about how the free market failed. The fact is the free market has never been given a chance. Government interference has fundamentally changed these markets. We call our markets free but they have not been free since around the time the constitution was ratified.

The really sad thing is that you have individuals that have been so programmed by the nanny state that they actually argue AGAINST their own freedoms. :suicide_fool-edit:
[/quote]


So then what freedoms are we losing?

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[quote name='John~Galt' date='25 February 2010 - 09:42 PM' timestamp='1267155767' post='865499']
It does if you remove barriers to competition. Allowing consumers to buy health insurance from other states would be a good start. Tort reform would be another good step.
[/quote]
Homer might have said this but I don't follow him anyway half the time with his smart speak. :fing03:

But Obama actually touched on this yesterday during his speech at the summit.
He said(and I'm paraphrasing) that if you allow this all the insurance companies will migrate to the least regulated states like the credit card companies did and impose all the fees and garbage the CC companies do and basically run rampant with profits and price increases year after year.
So in the long run it would actually not be the best idea to allow this.

He said it much better than me but maybe that's why he's president and i'm just a college student.

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[quote name='John~Galt' date='26 February 2010 - 11:45 AM' timestamp='1267202720' post='865599']
That's the point on a lot of these issues. People are spouting off about how the free market failed. The fact is the free market has never been given a chance. Government interference has fundamentally changed these markets. We call our markets free but they have not been free since around the time the constitution was ratified.

The really sad thing is that you have individuals that have been so programmed by the nanny state that they actually argue AGAINST their own freedoms. :suicide_fool-edit:
[/quote]
Markets never have been, nor will they ever be, nor ought they be, free--in the sense meant by the ideologues. And I've always thought it would be a good thing if there were more emphasis placed on the economic reasons for why this nation came into being. There are lots of myths to be exploded for the better, imo. A primary reason we had our Constitutional Convention was related to economic integration (or the lack thereof) and the debilitating effects associated with the Confederation.

That said, there is a lot of juice to be gotten from really examining the philosophical underside of our political system. However, and take this as a bit of tough love, John-Galt, objectivism isn't really philosophy. And libertarianism is, for the most part, a quest for the return of feudal society under the guise of some mythological freedoms which do not exist. Its "friend with benefits" is anarchism, another chimera.

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[quote name='Homer_Rice' date='26 February 2010 - 06:43 PM' timestamp='1267227834' post='865687']
Markets never have been, nor will they ever be, nor ought they be, free--in the sense meant by the ideologues. [color="#FF0000"]And I've always thought it would be a good thing if there were more emphasis placed on the economic reasons for why this nation came into being. There are lots of myths to be exploded for the better, imo. A primary reason we had our Constitutional Convention was related to economic integration (or the lack thereof) and the debilitating effects associated with the Confederation.[/color]

That said, there is a lot of juice to be gotten from really examining the philosophical underside of our political system. However, and take this as a bit of tough love, John-Galt, objectivism isn't really philosophy. And libertarianism is, for the most part, a quest for the return of feudal society under the guise of some mythological freedoms which do not exist. Its "friend with benefits" is anarchism, another chimera.
[/quote]


Interest is peaked.
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[quote name='Elflocko' date='26 February 2010 - 07:12 PM' timestamp='1267229578' post='865693']
X2
[/quote]

Just what the heck does the multiquote function do? Or am I doing something wrong? Anyhow wanted to quote both Jamie and ElFlocko here re "interest is peaked."

Got a specific question? Want a short bibliography? A Homer Rice rant about Beard's famous thesis or about the way that Madison and Hamilton took advantage of the failed Annapolis Convention? If I get to choose, it'll be the middle one.
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[quote name='Homer_Rice' date='27 February 2010 - 06:31 AM' timestamp='1267281088' post='865803']
Just what the heck does the multiquote function do? Or am I doing something wrong? Anyhow wanted to quote both Jamie and ElFlocko here re "interest is peaked."

Got a specific question? Want a short bibliography? A Homer Rice rant about Beard's famous thesis or about the way that Madison and Hamilton took advantage of the failed Annapolis Convention? If I get to choose, it'll be the middle one.
[/quote]


I'd be happy with the bibliography; less work for you and forces me to put some effort into it.


**Oh, and as for the multiquote, you simply hit that button on each post that you want to include in your reply, then hit the Add Reply button at the bottom of the page.
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[quote name='Homer_Rice' date='27 February 2010 - 09:31 AM' timestamp='1267281088' post='865803']
Just what the heck does the multiquote function do? Or am I doing something wrong? Anyhow wanted to quote both Jamie and ElFlocko here re "interest is peaked."

Got a specific question? Want a short bibliography? A Homer Rice rant about Beard's famous thesis or about the way that Madison and Hamilton took advantage of the failed Annapolis Convention? If I get to choose, it'll be the middle one.
[/quote]

Click the multiadd on both posts then rather than using that edit thing at the bottom click the reply button and it will take you to the advanced editor to use both.

[quote name='Elflocko' date='27 February 2010 - 10:16 AM' timestamp='1267283802' post='865823']
I'd be happy with the bibliography; less work for you and forces me to put some effort into it.


**Oh, and as for the multiquote, you simply hit that button on each post that you want to include in your reply, then hit the Add Reply button at the bottom of the page.
[/quote]


Biblio, some key concepts to google on myself, i dont want my homework done for me, agreed.
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[quote name='Elflocko' date='27 February 2010 - 10:16 AM' timestamp='1267283802' post='865823']
I'd be happy with the bibliography; less work for you and forces me to put some effort into it.

**Oh, and as for the multiquote, you simply hit that button on each post that you want to include in your reply, then hit the Add Reply button at the bottom of the page.
[/quote]
[quote name='Jamie_B' date='27 February 2010 - 12:04 PM' timestamp='1267290243' post='865848']
Click the multiadd on both posts then rather than using that edit thing at the bottom click the reply button and it will take you to the advanced editor to use both.

Biblio, some key concepts to google on myself, i dont want my homework done for me, agreed.
[/quote]
Got it. I wasn't hitting the bottom "reply" button; instead I was htting the last one in the queue of the two I originally wanted to quote.

Short biblio it is, then. Give me a couple of days to squeeze some time to put something coherent together. In the meanwhile, I recommend Bogart and Thompson's [url="http://books.google.com/books?id=IpXXAAAAMAAJ&printsec=frontcover&dq=bogart+thompson+economic+history&cd=1#v=onepage&q=&f=false"]Readings in the Economic History[/url] of the United States as a resource for jump-starting virtually any inquiry about US eco history (covers through the 19th c.)
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[quote name='Homer_Rice' date='27 February 2010 - 02:08 PM' timestamp='1267308504' post='865885']
Got it. I wasn't hitting the bottom "reply" button; instead I was htting the last one in the queue of the two I originally wanted to quote.

Short biblio it is, then. Give me a couple of days to squeeze some time to put something coherent together. In the meanwhile, I recommend Bogart and Thompson's [url="http://books.google.com/books?id=IpXXAAAAMAAJ&printsec=frontcover&dq=bogart+thompson+economic+history&cd=1#v=onepage&q=&f=false"]Readings in the Economic History[/url] of the United States as a resource for jump-starting virtually any inquiry about US eco history (covers through the 19th c.)
[/quote]


Thanks Homer!
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[quote name='Elflocko' date='27 February 2010 - 05:12 PM' timestamp='1267308747' post='865886']
Thanks Homer!
[/quote]


[quote name='Jamie_B' date='27 February 2010 - 05:35 PM' timestamp='1267310146' post='865889']
x2
[/quote]
I'm liking this multiquote thing. Doesn't take much to make an old man happy. Lol!

My mind is already churning a little about how I might organize a short biblio essay. We'll see if I have my old academic chops; I'll try to write it as I would have when I was a grad student. I'll try to cite stuff that is accessible online. It'll be a day or two as I am in the midst of an email correspondence regarding the Civil War and because I had to have two teeth pulled this week I'm a little behind on my "fun" tasklist. What I should have mentioned regarding Bogart and Thompson is that you could read through Chapter 5 which, interestingly enough, accords a fair amount of emphasis on credit, paper money, and some views on how this affects trade.
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