medical insurance has only accomplished successfully what all corporations want of their markets. (and some others have)

and, magically, when republicans are in power, all those markets tend the same way as the medical insurance markets.

how strange -- whatta coinkie-dink... whatta country!

Clinton, Ezra explained, presented reform as the system was changing dramatically,

The system is changing dramatically now. Markets are always changing dramatically, and they (almost?) change more flexibly than government programs.

Clinton, Ezra explained, presented reform as the system was changing dramatically, and American consumers shifted from indemnity insurance to managed care.

Actually finishing the sentence as you quote puts it back into context. Now, what was the point you were trying to make? Seems to me that the insurance market went to a rigid manged care market that has proven to be incapable of providing you know, care, in exchange for the premium dollars being paid into it.

maybe the 'manged' care is an appropriate typo. Freud Lives!

Exactly.

The Clintons didn't propose "Managed Care". They proposed "Managed Competition". COMPLETELY different. What we ended up with was the Managed Care/HMOs that the REPUBLICANS were pushing, that FAILED MISERABLY.

"The system is changing dramatically now."

Really? How so? As far as I can see, the status quo is very stratified and the people benefiting from it are working hard to stop any change.

"Markets are always changing dramatically,"

This is, at best, an exaggeration.

"and they (almost?) change more flexibly than government programs."

I could be snarky and agree with your typo that markets actually do not change as flexibly as government programs, but instead I'll ask you for proof of what you meant to say: that markets are usually more flexible than governments.

In my experience, markets tend to get very rigid, and businesses get powerfully set in their ways. I can't see that markets are any better than government when it comes to being flexible, particularly in the case of something like the health insurance industry, where a lot of power has been concentrated in the hands of very few people.

There are certain things that markets are good at, but there are also certain things that should not be for profit. Health care is one of those things. People who profit off other people's sickness and injuries are parasites, draining money that would be better spent actually taking care of people.

"The system is changing dramatically now."

Really? How so? As far as I can see, the status quo is very stratified and the people benefiting from it are working hard to stop any change.

"Markets are always changing dramatically,"

This is, at best, an exaggeration.

"and they (almost?) change more flexibly than government programs."

I could be snarky and agree with your typo that markets actually do not change as flexibly as government programs, but instead I'll ask you for proof of what you meant to say: that markets are usually more flexible than governments.

In my experience, markets tend to get very rigid, and businesses get powerfully set in their ways. I can't see that markets are any better than government when it comes to being flexible, particularly in the case of something like the health insurance industry, where a lot of power has been concentrated in the hands of very few people.

There are certain things that markets are good at, but there are also certain things that should not be for profit. Health care is one of those things. People who profit off other people's sickness and injuries are parasites, draining money that would be better spent actually taking care of people.

Markets are always changing dramatically, and they (almost?) change more flexibly than government programs.

A meaningless assertion given that the terms "market," "flexible," and "government program" have not been adequately defined, AND given that no facts are provided to support the assertion.

If you define "market" as the system of variables that describe the relationship between a consumer and a provider, then flexibility depends the structure of those relationships and the culture of both parties.

Don't confuse flexibility with price volatility. Price is just one of many variables that define the market. Flexibility means that the system itself is relatively amenable to change. That is, the value proposition changes, the relative power held by the consumer vs. the provider changes, the distribution mode changes.

Obviously, this varies widely from system to system. With regard to health care, the system is quite complex and quite rigid IMO. First, there is no simple relationship between provider and consumer because access and payment are controlled by a middle man. Second, the middle man has a lot more power than either provider or consumer, and the current structure of the relationships and the regulatory context in which it occurs preserves that power imbalance. Third, the system has virtually no meaningful competition from a consumers viewpoint because care is a necessity, and the number of insurers has been decreasing for years. Finally, the system is designed to optimize one variable for one participant -- profit for the insurers.

I would say it's a fairly rigid system that is headed for a collapse. Of course, it's an open system which means that it's possible that an "external" variable such as a disruptive technology could come in and really change the game for all participants (Napster for health care?), BUT that seems very unlikely from where I'm sitting.

http://www.indystar.com/article/20090726/NEWS05/907260351/Susan+Bayh+an+issue+in+fight+over+health+care

Susan Bayh, wife of senator Evan Bayh, earned $2.1 million sitting on the boards of health care companies.

On the front page of the Indy Star today.

Hopefully someone in the national press will run with it.

Ya gotta like this. "Bayh contends the $2.1 million that his wife, Susan, earned from public health-care companies from 2006 to 2008 represents no conflict of interest."

Er, if you're concerned about state level concentration, why not let health insurers compete across state lines?

"Markets are always changing dramatically..."

So that's why my health insurance went from $250 per month straight to $480 per month six years ago?

I heard Jim DeMint babbling repeatedly this morning about this "health insurers competing across state lines". Don't know what to make of that, but considering the source, I'm sure it's another "doogle".

"Some people say" everyone has access to the ER, so there's no need for major reforms.

But, if a lower-income working person has any income and they have to go to the ER for something significant they will come away from it with huge bills and they will go bankrupt.

That's why so many bankruptcies have to do with health costs.

Having an ER doesn't prevent it from ruining your life. Only those who are already at ground zero can use the ER and consider it a God-send. Everyone else who has to use it without insurance must consider it a major disaster.

We need everyone on insurance, so the working poor (or middle-class for that case) won't automatically be bankrupted by a medical emergency.

Republicans can make a lot of enemies by refusing to notice people are going bankrupt, but Democrats think it's a personal issue, a national issue and something we need to get done this year.

Health care/insurance this year!

"Er, if you're concerned about state level concentration, why not let health insurers compete across state lines?"

What, you think they aren't allowed to? The way monopolies and trusts work is either by buying out the near-by competition, or by negotiating with the other big fish to agree on who gets which markets. The concentrated markets we have now were designed by the insurance companies themselves, and they want to keep it this way.

Yes, some payers compete in multiple states, but they have to have separate plans regulated by distinct state regulators in each state they play in. Dramatically diminishes competition. Why not allow a resident of New York to buy health insurance from a Wisconsin plan? Would eliminate the state level concentration issue immediately.

>"Er, if you're concerned about state level > > >concentration, why not let health insurers >compete across state lines?"

>What, you think they aren't allowed to? The way >monopolies and trusts work is either by buying >out the near-by competition, or by negotiating >with the other big fish to agree on who gets >which markets. The concentrated markets we have >now were designed by the insurance companies >themselves, and they want to keep it this way.

The Kaiser Foundation in 2007 compiled OECD data from 2003 that showed the US spent $5711/person while amongst the other countries, Finland spent $2100, France $3,048, the UK $2317 etc.

Where might that money go since the US doesn't demonstrate health care twice as good as other countries nor do we get disease outcomes that are twice as good. Often, the US lags behind in life expectancy or infant mortality,

So where does that money go? Reread Ezra (I do what Fred Hiatt wants, I got a job at the WaPo, yay!) Klein in light of these comparisons. Hmmm.

Sorry

health-care premiums shot up more than 90 percent between 2000 and 2007, while the profits of the 10 largest insurers increased 428 percent over the same period.

This is should be repeated ad nauseum-- your health insurance didn't become more expensive, premiums went up for the sake of PROFITS FOR INSURANCE COMPANIES. This is about fat cats in the health insurance business getting rich off of the sick. The sicker you are, the more they make.

Also, sitting on a few health boards can net a person $2.1 million??!??

What I truly don't understand is that even people with great insurance (congresscritters and their families) still might need to use an ER every once in a while. Why do they want them filled with people who are just there to see a doctor? I guess that means none of them have sat in an ER waiting room for the standard 3 or 4 hours. That answer basically means I don't give a fuck about the poor-- let them sit for half a day and risk losing their job to see a doctor.

The reform effort in the 90's was partly undone by the strong economic recovery, bringing tens of millions of new jobs, that started as soon as Clinton took office. The issue became somewhat academic as new jobs brought insurance with them.

But this recovery is predicted to be nothing like that one.