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[Replaced_Texan]

Originally posted by Greedy,Greedy,Greedy
Ah, so much to deal with.

You can always try the Massachusetts solution -- once the insurance companies become sufficiently concentrated so that they have effective monopoly power in the negotiating game (take my price or your beds are all empty), just concentrate your hospitals sufficiently so that the two are on par. Then we have dueling monopolies, which is really significantly better than just one monopoly (Burger take note, some anti-trust issues in here).

Here, the problem of the uninsured is pushed heavily on to the Hospitals, and since they are all basically non-profits, they don't resist much, just negotiate carefully the details of their surrender. But most of their pricing is not driven so much by the ability of the uninsured to pay, but instead by the willingness of the governmental payors to pay -- once the Medicare/Medicaid rates are set, most of the rest seems to follow, including the relative imporance of one service versus another in the negotiations with the insurers. The exception here is the foreign payors, where there actually is something that looks more like a market, but not really big enough to have a big impact on pricing.

So effectively there are three negotiating monopolies: (1) hospitals; (2) insurance companies; (3) government, and the uninsured are then an after-thought.

What do I take from all of this? That the health care system has the flaws of partial regulation; unless we can find a way to fully regulate, all we're doing is trying to referee a street fight. And if we don't regulate, we are at this point leaving it to the monopolies, the strongest of which are insurance companies and government.

That's the same exact situation in Houston, except we have three not-for-profit hosptials controlling the show instead of two. (Four if you count the sisters for chairty, but after the elevator decapitation last year, they've had issues filling their beds.) The problem is that we as a people have a problem shoving sick and/or dying people out on the street and we have requirements about taking care of people who show up on the threshold (or 50 feet from the campus, whichever is closer), but we steadfastly maintain the illusion that we're operating some sort of capitalist enterprise here.