Why competition in health care sucks

[eridani]

--and why it should be a public good.

http://www.thelundreport.org/resource/is_competition_really_good_for_healthcare

The bronze and silver policies that most people will select under Obamacare have enormous deductibles so that people are discouraged from seeking routine medical care and from getting the companies to provide something in return for the premiums. And the companies will continue their efforts to avoid caring for the sickest patients and to deny coverage whenever possible. The “choice” in the “healthcare marketplace” is limited to policies of companies whose bottom line is not patient care, but profit. (The “not for profit” companies have the same bottom line as those that are “for profit”--they just have to call it something else.)

Is competition among drug companies a good thing? One would think that “ethical pharmaceuticals” would compete to offer the best products at the lowest prices. But like the health insurance business, the “competition” is only to see who can derive the maximum profit. We get the drugs that are most profitable and most easily marketed, not the drugs we need. And the price of the drugs is whatever the drug companies can get away with.

The business model of competition and profit seeking is even being foisted on doctors. “Pay for performance” is promoted as a way to get doctors to improve the care they provide. What an insult to the medical profession! Doctors don’t need a financial incentive to be motivated to provide quality care for their patients. When pay for performance has been put into effect, doctors and hospitals have shown that they know how to game the system, but there has been no evidence that pay for performance has actually improved patient outcomes.

If competition is so wonderful, why don’t we have competing police departments, fire departments and armed services? Clearly, the business model--competition and making a profit--is not always appropriate. The competitive model for healthcare is a terrible idea--inefficient, immoral, and colossally expensive. A recent study estimated that a single payer system would save $592 billion in administrative and pharmaceutical costs. Will we ever get a system whose bottom line is not making money, but caring for patients?

[magical thyme]

1. health INSURANCE is not health CARE

I have yet to see a single INSURANCE employee deliver one moment of health CARE.

Health INSURANCE companies make a profit by REFUSING TO PAY FOR HEALTH CARE.

[B Calm]

2. Real competition would of had a public option!

[GreenPartyVoter]

9. Exactly. And that is exactly why we didn't get one.

[pnwmom]

11. We didn't get one because Lieberman was the key NO vote

on the public option -- we needed all 60, including the Independents -- and Lieberman represents Connecticut, the headquarters for major insurance companies.

[B Calm]

13. That's right, thank's for jogging the old memory hole!

[GreenPartyVoter]

14. Exactly!

[area51]

10. +1 n/t

[jsr]

3. When in need of medical care, always look for the best billboard

[MisterP]

5. "yo!"

[CTyankee]

4. You cannot make a profit insuring old and sick people. We cured the "old" problem by establishing

Medicare, the poor with Medicaid. But this system requires healthy people who become sick or injured to impoverish themselves in order to get government assistance. This is just wrong.

[FarCenter]

6. We have competing police departments and armed services

In some places municipal, county and state police departments provide somewhat overlapping functions and they compete for funding, etc. with their respective political bosses. Also, there are actually more private guard service employees than there are police officers.

The marines compete with the army, navy, and air force. The navy competes with the air force. We also have private military forces such as Blackwater and others. The most lucrative part of the armed services is probably the production of ships, planes, vehicles, guns, ammo, etc. which is all done by private industry under a complex and bureaucratic procurement scheme.

In fact the military industrial complex and its procurement systems is probably a good model of where health care is going.

[eridani]

7. The navy competes with the air force = pure bullshit

They don't compete to provide services to the US public--all they do is fight over federal dollars, hardly the same thing. Competing for public funding is ssue the hel NOT competition in the market sense.

[GreenPartyVoter]

8. That is what I expect we will do. Cut down on our doctor visits.

[joshcryer]

12. Here's what needs to be done with single payer.

Every time it's broached it's all about it's untenable, not politically viable, etc. No one ever says why it's not politically viable or its untenable. There's a reason they believe that and politicians aren't necessarily utterly stupid.

Well, the idea is, if you read between the lines, is that single payer would put about 250k health insurance workers out of a job, pretty much overnight. So rather than waffle and say "it's politically untenable, it's not viable," I think single payer advocates need to come out and say the absolute truth.

"Single payer makes about 250k people lose a job, so we propose 2 years unemployment plus job retraining for those individuals."

It's so simple it's a joke but no one is really addressing the "political downside" to single payer. The politicians are just cowards, they don't want to vote for something that will end with "X politician voted for single payer which led to 250k jobs lost." And they are damn afraid of making the argument that they literally want to put 250k people out of a job and retrain them for something else.

Single payer is such a winning strategy that I don't know, I feel like I should just run for politics just to cut the bullshit. Be up front about this crap.

edit: let me note one thing, single payer advocates rightly note that it would lead to a net job increase, however, the job increase is in the health care field, nurses and the like, not insurance sales agents, those agents will need to be retrained, so this isn't an argument against single payer, I'm just trying to say we need to accept the reality of single payer. Maybe 20% of those sales agents will go on to be nurses or whatever, that's beside the point. They need unemployment and free job retraining in a field that they will like otherwise you wind up firing 250k people in short order and the political backfire from that is goddamn epic. It's one reason I don't think single payer advocates in congress are really serious about it, because they don't include these provisions to protect these workers.

[eridani]

17. The job increases are not just in the health care field

All employers, government and private alike, would be free of wasteful private insurers and could therefore afford to take on more employees. (Of course the retraining issue is still there.)

Single Payer Health Care—a Stimulus for Economy with 2.6 Million New Jobs, $317 Billion in Business Revenue, $100 Billion in Wages
New study sponsored by the California Nurses Association


Full study: http://www.calnurses.org/research/pdfs/ihsp_sp_economic_study_2009.pdf

Establishing a national single-payer style healthcare reform system would provide a major stimulus for the U.S. economy by creating 2.6 million new jobs, and infusing $317 billion in new business and public revenues, with another $100 billion in wages into the U.S. economy, according to the findings of a groundbreaking study released on January 14, 2009.

The number of jobs created by a single-payer system, expanding and upgrading Medicare to cover everyone, parallels almost exactly the total job loss in 2008.

These dramatic new findings document for the first time that a single-payer system could not only solve our healthcare crisis, but also substantially contribute to putting America back to work and assisting the economic recovery," said Geri Jenkins, RN, co-president of the National Nurses Organizing Committee/California Nurses Association, which sponsored the study.

[joshcryer]

18. Fixed link:

http://www.pnhpwesternwashington.org/PAGES/ihsp_sp_economic_study_2009.pdf

Plus a trove of other documents in that directory: http://www.pnhpwesternwashington.org/PAGES/

You're of course right and that paper says that health insurance hires over 700k people. I expect 90% of them will be out of a job. Overnight. They include compensation benefits at the bottom of the paper.

[eridani]

19. Yes--but retraining funds are included in most state single payer bills

Besides which, "what about the jobs" is a piss-poor argument for continuing to pursue vicious, socially harmful policies. Like the War on Some Drugs? What about all the prison guards that would be laid off if we stopped it?

[joshcryer]

21. I don't disagree.

But that's what the cowardly Democrats feel and it's why it was never at the forefront of top official policy.

It's a shit reason.

[Nuclear Unicorn]

15. What an absurd premise. Police and the military are the force of the state.

and the state, almost by definition, is a monopoly on force. However, if this silliness is to be entertained it should be noted that groups and units within the same military are highly competitive with their peers. I would also suggest military contractors that aren't cost competitive and are inefficient while failing to satisfy consumer demand won't prosper as well as their rivals.

[Recursion]

16. Eh. It's great in some things. We want more competition with drugs, for example

And devices. And even some commodity services like wellness care. Other things, not so much.

In terms of being a public good in the strict economic sense, it's both rivalrous and excludable, so it's not technically one (it's a public good in the normal sense of the word, but that phrase has a specific meaning in economics).

[Yo_Mama]

20. There isn't even competition in a lot of areas

http://www.cnbc.com/id/101140469

Of the roughly 2,500 counties served by the federal exchanges, more than half, or 58 percent, have plans offered by just one or two insurance carriers, according to an analysis by The Times of county-level data provided by the Department of Health and Human Services. In about 530 counties, only a single insurer is participating.

The high deductibles are by design, not because of the insurance companies. The 70/30 60/40 (silver/bronze) is written right within the law - it was designed to "bend the cost curve downwards" not for the insured person, but to limit medical care so as to limit national medical expenses.

I'm sorry, but the move to blame the insurance companies for this, much as I hate the bastards, is completely delusional.