This is THE single issue that impacts my quality of life most. The financial and psychological burden of healthcare in this country has been staggering for me. I tend to get overwrought just thinking about it.

Anyone who cares to see my unusual insurance stories can go here: http://biznik.com/articles/free-market-government-solutions-to-health-care

But I just had to share this link to PHYSICIANS FOR A NATIONAL HEALTH PLAN. They have some GREAT information germane to this issue.

http://www.pnhp.org/facts/singlepayer_faq.php#rationing

Here's hoping!

Thanks for tolerating and responding to my diatribe so nicely. I think that a lot of my arguments against for-profit health care apply equally well to hospitals as well as insurance companies. Still a captive market (at least in the case of emergencies and rural areas), still pressure to provide "cheaper" care while charging more, still the legal protection and incentives of private businesses to remain "opaque".

If the market had the power to clean up this system, it would already be working demonstrably in places like Seattle, where there are several excellent hospitals and many insurers within spitting distance of each other. Instead they all utilize the same evil tactics. FOR PROFIT.

Another huge issue that neither you nor that article address is the cost of uninsured people to hospitals and our society as a whole. Kaiser Permenente reported that in 2004 that "uncompensated care" totaled $40.7 BILLION. Imagine if the hospitals actually got paid for ALL of the care they provided? Recently I called my hospital to ask about a payment plan for a large bill. Their rep immediately offered me a 10% discount if I paid my bill in full immediately. Clearly they often don't get reimbursed for services provided and are happy to get what they can. (But if I hadn't called I wouldn't have gotten that offer, which isn't fair to people who pay without asking questions.)

Studies also show that uninsured people let medical problems progress further to more severe (and expensive) problems before seeking treatment. See the link below for more interesting stats. Again, this is a hidden cost to all of us that we are unknowingly paying for already. Eliminate it by providing blanket coverage and you remove much of the burden to hospitals and other healthcare consumers.

One last comment regarding insurers not being complicit with high healthcare costs. Last year, on the advice of my doctor, I decided to try a new treatment for a chronic condition. I had to wait over a month for some secret review panel at my insurer to approve the procedure (I was not allowed to contact them directly). Finally it came. I scheduled the appointment and received a quote for all hospital charges (1 five-minute procedure necessitated two physician fees, two facility fees and one pharmaceutical fee.) A month later, I had the procedure. A month after that, I received an "explanation of benefits" from my insurer, and the hospital fees were close to the mark. But I noticed that one fee adjustment column raised the price by $600 instead of lowering it. When I inquired about this the insurer's people told me several times that they had a contractual obligation to pay THAT amount, and so they, and I, were just going to have to pay it. Even though the hospital hadn't asked for it. Because I have coinsurance, this increased my bill by $120. When I called the hospital to ask about another item on the bill, they lowered my total by $250 because they agreed that it was "confusing".

Once a hospital billing rep told me outright that it's too difficult for the hospital to keep all the different contractually agreed charges straight, so the hospital policy is to overcharge for everything, and then let the individual insurers adjust fees down. (Guess they underestimated one time with that procedure of mine.) This system ensures that people who are un- or under-insured get charged BADLY INFLATED PRICES. (This might be you, Matt!)

THIS SYSTEM IS CRAZY. I know that just dealing with this has shaved years off of my life. (Perhaps THAT is why we rank 50th in life expectancy?) So far I have tried four hospitals in Seattle. Every single one does these things, to only slightly greater and lesser degrees. Like I said, the market isn't fixing problem! For your own and other small businesses' prosperity, please reconsider your stance.

Or at least read this article :)

http://www.kff.org/uninsured/upload/The-Cost-of-Care-for-the-Uninsured-What-Do-We-Spend-Who-Pays-and-What-Would-Full-Coverage-Add-to-Medical-Spending.pdf

Hi Matt. I was led to your article from your comment on Len's article about his experience as a small business owner under the Canadian health care system. I'd like to return the favor with a couple of comments from my own lengthy personal experience with the US system. Your arguments are good, except that you fail to consider the specific nature of the industry that you'd like to see "compete", and how they would actually go about doing that. Because they DO compete now within states, and the result, for us the consumers, is BAD.

The main difference between the US and all other first-world (and many second and third-world) countries, is that we let health care be FOR-profit at all. Innovation does occur- lifestyle drugs like Viagra and drugs that manage symptoms and new "syndromes" are developed; cures for rare cancer are not. Why? NOT AS PROFITABLE.

What do the insurance companies ACTUALLY do RIGHT NOW to increase profits and make themselves "more competitive"? 1. Deny coverage 2. Increase premiums 3. Deny claims 4. ADJUST HOSPITAL CHARGES (you seem strangely ignorant of this fact) 5. Pay less than 100% (usually only 70 or 80% now) 6. Advertise and lobby LIKE CRAZY against reform (so far they've spent $9,529,747 on lobbying ALONE this year. That money could be going for research and HEALTHCARE.)

Interestingly, efficiencies and appropriateness of CARE is often NOT investigated here- at least not by the private companies. Why? Because reasons 1-6 work SO WELL! Case in point: I recently sprained my ankle badly in an accident (ie- I wasn't "asking for it" or being negligent with my health, Chris). While waiting and WAITING (over a month and a half) for my appointment with a specialist here in Seattle, I researched treatment options online. I found one great study for the most efficacious treatment of sprained ankles. Guess who commissioned it? The British National Health Service's National Institute for Health Research.

In the same accident I also dislocated my kneecap. Still waiting to see that specialist (I'd also waited over two weeks for an MRI because I'd needed insurance "pre-approval"), I again researched treatment options. I found a great study comparing surgery and conventional treatment that found in favor of the more expensive surgery. Guess where that study took place? Finland. As in, national health care for all, top ten best countries for infant mortality rate (US is 46- below Cuba and Guam according to the CIA World Factbook), much better life expectancy than the US, despite our staggering medical innovations . . . .

Now I am getting letters from my reputable insurer saying that the hospital claims relating to those accidents are being held up because they need "more information"- ie, they want to know if they can sue someone else or foist the bill off onto another insurance company. Red tape and inefficiency that would not exist under a single-payer system (did you know that private insurance bureaucracy and paperwork consume one-third (31 percent) of every health care dollar?). I have been through this before. Let the paper shuffling and headaches begin. And I get this treatment despite being financially crippled by paying for a premium plan- the one that out-competed all of the others and got my business.

Which brings me to the second major problem with your comparison of health insurance companies to ABC Widget Company. Unless these widgets are a life-necessity, and create CAPTIVE consumers, these are definitely apples and oranges my friend. Because even though my insurer just jacked up our rates by $80 each month to $600 EACH MONTH, I can't leave them because I have "pre-existing conditions" now. I am stuck, and they know it.

So now they will raise my rates to offset raised hospital costs, which offset raised uninsured, underinsured, and, yes, under-funded government-plan most-needy patient care. Yes, Chris, whether you like it or not, YOU ALREADY PAY for your needy fellows. The only difference is that with this system EVERYTHING IS OPAQUE and obfuscated. (Just try getting a good quote for a procedure before you get it. Did it include the $3,256 "facility fee"? How about the $476 "non-sterile units"?) Everything is confusing, harder to question and fight, and, hence, MORE PROFITABLE! And by the way, doctors HATE this system. Just visit the PNHP to learn more about that: http://www.pnhp.org/facts/singlepayer_faq.php )

By the time you regulate all of these problems away to make a private industry act just like a public one, you have just added MORE complexity and bureaucracy to an already ludicrous system. We tried that with firefighting (another life-or-death "industry", and it didn't work.

We trust the government to take our 911 calls, to educate our children, to keep our bridges and buildings up, to keep us safe in so many ways. When are we going to join the rest of the informed world and GET SMART ABOUT THIS?

For-profit insurance article - http://voices.washingtonpost.com/ezra-klein/2009/06/the_truth_about_the_insurance.html