No reason, I guess? Just a blank space?

Nevermind its up now

Proud of Merkley. Fed up with Wyden.

The quote "A public option seeks a different target, providing the highest quality of health care at the lowest cost to both the the system and the consumer"

Sounds like the goals of our DMV and Post Office. When are we going to learn adding addition layers of bureaucracy, regulation, and of course increased cost, it take's away freedom of choice, innovation, which help lower our cost, Competition helps provide higher level of care.

Lets help lift the standard of living of our poor, not lower. Lets be progressive and put right decisions for the right reasons above our politics.

Begin single-payer advocate hair-splitting:

rdurig, you forgot to mention that a public option is socialism and a government take-over of health care. You also forgot to deny that for-profit insurance companies limit choice, fix prices through an exemption from anti-trust law, add layers of bureaucracy, add regulations, stifle innovation, and increase costs without providing any health care at all.

It would be so easy to expand Medicare to cover 100% of the country, to tweak the Medicare payment system to fairly compensate providers, and to increase the Medicare tax enough to cover the cost. But it will not happen.

Screw the poor.

God Bless Wall Street.

The problem is health care and insurance is not he proper role of government. This is a collective power, which is a very dangerous power to give government (not that it has not given itself tons of illegal collective powers already). The whole foundation of our nation was to avoid such power manifested in the hands of a few. Don't get me wrong. I think most insurance companies offer fraud instead of coverage, we would be better of defining what can be called insurance in our market and creating a competitive environment or creating a non-profit who's sole purpose is to provide low cost insurance. Government regulations prohibit many of these remedies including alternative cures. Government is the problem folks. Don't ask the fox to guard the hen house. Demand changes in the current law the dis empower government and create results.

DeanOR, what evidence would you cite as proof that insurance companies "fix" prices and that they are enabled to do so by the anti-trust exemption?

doctor, if you're really 'concerned' about all of those lost patients and their quality of care you have a very simple solution. you merely sign up with the other provider network in addition to the current network(s) you participate in.

Of course that would be full disclosure and it might even cause you to take a little less in payment for your services. But then that would be in opposition to the point you just tried to make about the big, bad insurers then wouldn't it?

Galen, The proper role of government is watever the governed say it is. When the private sector has demonstated so convincingly that it can not or will not provide what society requires (as whith health care coverage) then it is the responsibility of government to fulfill its obligation to the citizenry and make the necessary changes. That is certainly what happened with the creation of Medicare and Social Security. It is instructive to note that the 36 countries that have better health outcomes than the US all have more government involvement in health care than does the US. And I would say that the US and its citizenry have created a government that is at least as capable as those other 36 national governments.

DeanOR

Your quote

"You also forgot to deny that for-profit insurance companies limit choice, fix prices through an exemption from anti-trust law, add layers of bureaucracy, add regulations, stifle innovation, and increase costs without providing any health care at all."

We have built such a complex and regulated system, including insurance, medicare, and health care, that it is truly a bureaucratic, legislative and administrative nightmare, for all parties involved. It's hard to believe but all the rules and regs have just pilled on so much that is the single reason why the whole system a failing.

The more freedom of choice, the freer the market and yes we need to free up insurance industry, and it would be shocking how very quickly competition will weed cost down.

Lets help the poor, and lift our American Standard of living, allow more personal freedoms and less government.

rdurig, your market fundamentalism is just as mindless as Jimmy Swaggart's xtian fundamentalism. The invisible hand will not save you; in fact, it has sent the economy over a cliff. Time to grow up now. Join the rest of the planet. Single payer.

Please stop the attracts and at least try be progressive and professional. Attacking is poor way to show anger and hide the truth.

You say free market don't work well, compare. North Korea to South Korea, China to Hong Kong, East to West Germany they all started at the same time. It's proven that the higher level of personal freedom the higher level of society standard, and that lets lift the poor.

PS Hitler used attacking other to hide his unethical policies. If we go to best decisions for best reason with real transparency, before politics we could turn our country great again.

You can get full medical coverage at the lowest price from http://bit.ly/atGzeD

When are we going to learn adding addition layers of bureaucracy, regulation, and of course increased cost, it take's away freedom of choice, innovation, which help lower our cost, Competition helps provide higher level of care.

I agree. The layers of bureaucracy, regulation and increased cost in the current, private, for profit insurance system that lets gigantic conglomerate dinosaurs run rampant through the system has gone too far. The competition of a strong public option ought to whip those inefficient behemoths into line, as it has done in most other industrialized nations.

Er...that is your point, right?

It's in the interest of all of us that Dr Tewfik be able to spend his time and energy practicing medicine, not figuring out who will pay, how to get them to actually pay, how much is covered, what the patient can afford, what treatments are covered by dozens of different insurance companies, what to do when the patient's insurance changes or is cancelled, etc. Insurance companies do not provide health care. Too often they deny it or cause delay and interference in medical decisions and the doctor-patient relationship. I support Medicare-for-all, but a strong public option would be a great improvement over what we have. It's the very least we should have. The influence of corporate money over government, to protect their profits, is why we didn't have it a long time ago. Thanks for your column Michael

you replace small bureaucracies (insurance companies) with even larger bureaucracies (governemt) again that would only increase the problems, while giving us DMV /POst offive tpye waiting lines.

I like Kari solution and quote

Kari Quoted

"RDurig wrote: Lets increase free market competition, so we could lower cost of medical help, and increase the level of health care.

I wholeheartedly agree. The problem is that in many states there is only ONE insurance provider. In most places, there are only two. That's not free market competition. Furthermore, even where there are multiple insurance companies, most individuals only get one choice through their employer. That's not free market competition.

Personally, I agree with Ron Wyden that the best solution is to end the employer/health-care connection. Decouple employment from health care and everyone becomes free to shift their personal health care to another company with better rates, better service, etc. (Just like auto insurance.)

In the absence of that radical reform, adding a public option would be a great to create free market competition. Simply give employers another choice, and you'll get downward pressure on prices.

Free market competition really is a big part of the solution. What I don't understand is why so many conservatives, who are usually free market absolutists, fear the free market solution in health care.

Private monopolies and cartels can be just as oppressive to freedom as are governments. In fact, they're often even more effective, because they don't even pretend to be democratically and transparently governed."

the republicans consist of mostly wealthy white people who think we are in a giant game of Monopoly, or the Golden Rule. Its all about getting every dollar out of your wallet before someone else does and forget the people. ELECT THE GOP AND TO WAR WE GO. Throw in economic slavery and we are in the old south agin. 50yr old white male saying god help us all.

increasd competion,yes. consumer protection,yes. increase supply of doctors and specialist. Require access to speciists and surgical options so I can get a hip and back surgery soon and get off of soc. sec. disability! I pay $1600 a year for med and rx and that payss for all the doc visits and drugs 2x over that I see and use. But I dont qualify for any surguries. Should I just go have an accident so Ill be f--ked up enough?

the republicans consist of mostly wealthy white people...

When will people realize that this is a myth? Most Republican voters are low income, living in rural areas. Other than race, there is no better predictor of voting patterns in a given area than income, the poorer the redder. Unfortunately, partisans on both sides drag out this canard, since both sides believe that it somehow helps their cause.

I see that DeanOR chose not to attempt to answer my question.

@Dan Petegorsky

Please explain to me how the sole example you give has anything to do with the anti-trust exemption. If the activity in question were enabled by the anti-trust exemption, why would UnitedHealth be exposed to legal action?

Of course you said that was "for starters"; what other evidence do you have?

The anti-trust exemption also applies to property/casualty companies. If the anti-trust exemption enables cartel-like activity you should be able to find plenty of collusion in the P&C industry as well, no?

Do you think the state insurance regulators do a bad job of policing such activity in the health insurance and P&C industries? What exactly does the anti-trust exemption cover anyway? How do you evaluate the plusses (if there are any) and minuses of the anti-trust exemption and conclude that it should be repealed?

Dan, you Googled because you had no idea what you were talking about and simply found something that used the sensationalist expression "price fixing." You can't demonstrate how this example actually has anything to do with the anti-trust exemption because it doesn't.

I've been doing some research to examine what sinister behavior the anti-trust exemption enables and so far haven't found any. I start to think that "anti-trust exemption" is misinterpreted as "freedom to act as a cartel" and repeated by people who know what anti-trust means in general but have no idea what the McCarran-Ferguson anti-trust exemption for the insurance industry specifically enables.

Your comment about state laws is inane. If the state laws disallow what the federal anti-trust exemption allows, then the exemption is pointless and so are arguments against it on those grounds.

How precisely do you think federal regulators will do a better job than state regulators do? And don't give me some generalized blather about "consumers are raped by insurance companies and federal regulators will save them"; tell me specifically how state regulation enables bad behavior that repeal of the anti-trust exemption will correct, and how it will do so. If you can't do that, you're just talking out of your posterior.

"It's hard to believe but all the rules and regs have just pilled on so much that is the single reason why the whole system a failing."

Failing for whom?

Wellpoint just posted record profits AND just jacked their rates by double digits.

Oh, and they just dropped a couple of hundred thousand medically fragile clients from their rolls.

Just wondering, who contacted whom first?

Back to politics, the much more relevant question is why Obama is the one trying to kill it since day one.

Dan,

I thank you for linking to something relevant, though I must point out that until this point you had not provided examples but merely reiterated your prejudices along with a bad example.

I do appreciate the DOJ document and find it useful. I don't find it decisive. It is still not "obvious that the health insurance companies are engaging in practices that cause enormous harm," as a result of the anti-trust exemption. The DOJ piece raises that possibility and suggests that it can and maybe has happened on occasion, but it's empty of specifics. The piece also affirms the pro-competitive dimension of McCarran-Ferguson and the need to preserve it.

You assert that the exemption has been harmful without providing a basis for that assertion. Similarly with your allegation that states lack the will and resources to enforce regulations. My impression is that state regulators have will in abundance. As for the resources point, the claim seems reasonable, but you don't substantiate it. The fact is that all insurance rates must be reviewed and approved by regulators.

The quote from the Antitrust Modernization is unobjectionable. The question is whether the exemption in fact does enable collusion. The health insurance industry seems less competitive than the property/casualty business in terms of number of participants. However, both industries fall under the exclusion. So perhaps some of the relevant differences have more to do with the health insurance industry than the exemption.

The National Association of Insurance Commissioners insisted in an Oct. 21, 2009 letter to Sen. Pat Leahy that, "bid rigging, price fixing and market allocation... are not permitted under the McCarran-Ferguson Act and are not tolerated under state law." They add that "state regulators actively enforce prohibitions in these areas."

An analysis by the Congressional Budget Office last October said that new provisions relating to repealing the exemption in the Affordable Health Care for America Act "would have no significant effect on either the federal budget or the premiums that private insurers charged for health insurance."

A Congressional Research Service analysis from last August says that, "Given the courts’ narrowing definition of the ‘business of insurance,’ they would not be likely, in any event, to find such activities as market allocation, tying, or monopolization protected by McCarran-Ferguson from the application of the antitrust laws.”

An article from the Bureau of National Affairs says the following:

“Attorneys who spoke to BNA said... there is no evidence that the act has been an impediment to either federal or private efforts to prevent or curtail anti-competitive conduct in these sectors”. ‘The article also quoted Jack A. Rovner, with The Health Law Consultancy in Chicago: “While the law does not have much impact on the health insurance industry, it makes a good political target,” he said. “This is more about politics than an effort to correct anti-competitive conduct by health insurers because the fact of the matter is that repeal would not make a significant difference with respect to either compliance or enforcement,” Rovner said. “McCarran-Ferguson has never been a valid defense to the price-fixing or other per se antitrust law violations targeted by the legislation, whether pursued by government or private parties,” he added. “While repeal could have a significant impact on the balance of state and federal relations, the proposed legislation will not change a lot in the legal landscape concerning the way health and malpractice insurers are regulated,” he said.”’

A Feb. 7, 2010 McClatchy story ("Analysis: Stripping health insurers' antitrust protection won't affect consumers much") quotes Paul Ginsberg of the Center for Studying Health System Change: “‘I don't think this will have much effect. This is strictly political posturing.’…In fact, Ginsburg said, insurers already are prohibited from colluding to raise prices and from merging at will. They can, however, pool information about risks, and it can be argued that that helps them manage ways of controlling costs and even rates.”

Given these and other resources I've come across, it seems to me that the anti-trust exemption is not a significant factor, if a factor at all, in driving the high cost of healthcare. However, it reinforces the pantomime villain characterization that triggers the salivary glands of those susceptible to the stereotype.

Pat,

I thought it was a virtue to comment on something about which I'm not entirely uninformed. How is that not "honest debating on the merits"? Not that I couldn't comment on other issues pertaining to the original post or that have come up in the comments...

Why not expand on the merits of the CFA's case? Clearly there are differences of opinion, and as I said, I found the DOJ document helpful. I don't assume that the CFA folks are far left whackos, etc. Is suggesting that I do your idea of debating honestly on the merits? "Near left enthusiast" is probably a better characterization of the CFA, but I'm just guessing. They might be right, they might be wrong. Do you think the sources I quoted are "far right whackos"?

If the repeal of McCarran-Ferguson interferes with the procompetitive features of the exemption that the DOJ document referst to, then it's conceivable that it could harm competition. The sharing of loss information would appear to help smaller companies relative to larger ones, because the latter have larger pools of their own information. Many of the observers I've seen quoted don't talk about harm so much but express doubts that repeal would have any positive impact on competition. If I had to vote, I'd say "no effect."

I suspect that repeal would have other effects that would cause increased cost, confusion and inefficiency, at least for a time, since it upsets a system that has been in operation for a long time and changes law. One would have to do a cost/benefit analysis to know whether it was worth it. The larger question is whether it's worth the attention it's getting relative to other causes of high healthcare costs.

Dan, with regard to the New York case, it didn't seem to be a matter of insurance companies colluding but rather a service recommending or establishing rates based its recommendations on input from insurers/payers rather than from providers — the payers said something should cost X, but the providers generally sought higher amounts. I have found that the mere mention of a phrase such as "price fixing" should be regarded with skepticism. I happen to believe that insurers often abuse their position relative to policyholders, particularly in the use of litigation. However, I also know that politicians commonly pander to the public by taking actuarially unsound positions. The Florida homeowners market is a good example of this, as is the entire federal flood insurance program, which is a fiscal disaster precisely because it's built on fanciful premises and pandering.

I originally reacted to DeanOR's post because I had been thinking about the subject. A friend asked me to comment on a New York Times editorial by Robert Reich a couple of days ago and then I happened to come across a document addressing the antitrust issue as it pertains to the property/casualty industry. I hadn't ever studied that issue, but it had appeared a great deal in the rhetoric surrounding the healthcare debate. I certainly had no inclination to support an antitrust exemption but I had no idea why it should be there. Having been provoked by circumstance into taking a closer look, it began to appear that it was something that sounded sinister but really wasn't. I began to think people were repeating it without understanding it.

I don't know if it's accurate to say that there's no real competition in the health insurance market. However, it certainly is less competitive than the property/casualty industry, as measured by the number of choices. The thing is that the antitrust exemption applies to P&C as well as health, so it seems unlikely that the exemption is the cause on that ground alone. Both industries are state-regulated as well, of course. I suspect that there are several other industries without an antitrust that resemble the health insurance industry in terms of the number of competitors and the relative predominance of big players. I doubt, however, that those industries have any non-profit companies among the big players, as the insurance industry does.

"No, that's not in question. When an industry is singled out for protection from oversight, collusion is enabled by statute."

Perhaps, but the health insurance industry isn't given protection from oversight; it's given the green light to share information that would otherwise not be shared (loss information), and that same information is available to the regulators. The resulting rates are also reviewed by the regulators. It's done deliberately (from a regulatory point of view) for actuarial purposes, not for the kind of market intelligence purposes normally associated with trust activity, which further more is concealed from oversight.

Posted by: Pat Ryan | Feb 26, 2010 12:02:23 PM

Idler, very astute of you to challenge DeanOR based on a single datapoint.

In fact, it can't be a testable hypothesis as there are no degrees of freedom. Try to use a parametric test with 0 degrees of freedom. But, as Pat pointed out, that was the point of the gimmick.

Back to politics, the much more relevant question is why Obama is the one trying to kill it since day one.

I would also like to hear that addressed. It seems odd for BO to be promoting something when the wet blanket is being applied by the White House. Yeah, most want the public option. Why are the Dems dragging their feet so much?

It's nice to note that it's no longer a case that socialized medicine- why is that old chestnut not being bandied about- does not automatically get rejected by physicians. Meanwhile big Pharma and the insurance industry have their way. Next time you hop in the car for a solo, discretionary trip, or use a plastic bag from the store, instead of bringing your own, consider that every major policy decision in the last decade has pandered to big oil. Pharma is just as much about big oil as ExxonMobil is.

What "gimmick," Zarathustra? I had a genuine interest in a topic about which I thought someone was commenting without knowledge. In any case, it wasn't a "data point," it was a sub topic about which a book could be written.

There was plenty of room to argue the question one way or the other so what you say clearly doesn't make any sense. Is throwing out dismissive nonsense in lieu of a cogent argument your "gimmick"?

Sorry, Idler, don't see it that way. If you have one fact and you repeat it for 150 pages, that doesn't turn a single data point into a body of evidence.

I think you'll find I appreciate your sincerity more than most do on here. Sorry if it didn't sound that way.

I appreciate the courteous reply, Zarathustra.

There's no reason someone shouldn't choose to focus on the one issue that happens to interest him. One could say, for example, "I agree with several points you've made, but I must insist that I find this one particular claim questionable."

<h2>Other interlocutors may argue that it is a small point, but even if it is, a small point is not an invalid point. I would add that "point" in this sense is not the same as a "data point."</h2>