Sen. Bernie Sanders told CBS News he's "very disappointed" by the bill to end the government shutdown, calling a planned vote on health insurance subsidies "meaningless."
Only the first one can be fixed by competition, the rest aren’t impacted by that at all. There are too many moving parts for it all to magically go away by just saying “make them compete”. For instance what happens when insurance companies compete to offer the best deals on group rates to employers but then charge exorbitant premiums to employees? Or what if insurance premiums all magically came down but pharmaceutical prices kept skyrocketing?
Medical costs are an inelastic demand as well as a non-discretionary expense. That’s an absolutely terrible combination which means they’re almost entirely isolated from market forces.
Consider for instance a situation I find myself in. I need a certain medication for a permanent medical condition. Fortunately there are multiple medications available (often due to patents there’s only a single option). Unfortunately I’m allergic to all but one of them. That means it doesn’t matter if the pharmaceutical company is charging $5 or $5000 I’m paying for it. I literally have no choice. Whether my insurance pays for 100% of that or 0% doesn’t change what the pharmaceutical company is charging. Further for insurance I was offered a choice of about 5 different plans through my employer (which is a lot by most standards, often employers only offer one or two plans). My insurance is by all metrics terrible, I pay thousands of dollars every year in deductibles, but once I hit those deductibles it covers everything at 90% which with my medical expenses save me tens of thousands of dollars a year. There are cheaper plans of course, but then the tradeoff is that I’m restricted to a tiny handful of doctors who are all terrible and every single medical decision has to be pre-approved by the insurance company or they don’t cover it and I’d rather pay the extra thousand dollars a year to keep those decisions between me and my doctors.
The US medical system is a hydra and fixing any one part doesn’t actually solve anything. The entire system needs to be overhauled top to bottom. Switching to a single payer system is just the first step in that process but it’s a necessary one because otherwise the problem is intractable. It’s likely the patent system is going to need to be overhauled at least with regards to medications before it’s fixed as well.
Only the first one can be fixed by competition, the rest aren’t impacted by that at all. There are too many moving parts for it all to magically go away by just saying “make them compete”. For instance what happens when insurance companies compete to offer the best deals on group rates to employers but then charge exorbitant premiums to employees? Or what if insurance premiums all magically came down but pharmaceutical prices kept skyrocketing?
Medical costs are an inelastic demand as well as a non-discretionary expense. That’s an absolutely terrible combination which means they’re almost entirely isolated from market forces.
Consider for instance a situation I find myself in. I need a certain medication for a permanent medical condition. Fortunately there are multiple medications available (often due to patents there’s only a single option). Unfortunately I’m allergic to all but one of them. That means it doesn’t matter if the pharmaceutical company is charging $5 or $5000 I’m paying for it. I literally have no choice. Whether my insurance pays for 100% of that or 0% doesn’t change what the pharmaceutical company is charging. Further for insurance I was offered a choice of about 5 different plans through my employer (which is a lot by most standards, often employers only offer one or two plans). My insurance is by all metrics terrible, I pay thousands of dollars every year in deductibles, but once I hit those deductibles it covers everything at 90% which with my medical expenses save me tens of thousands of dollars a year. There are cheaper plans of course, but then the tradeoff is that I’m restricted to a tiny handful of doctors who are all terrible and every single medical decision has to be pre-approved by the insurance company or they don’t cover it and I’d rather pay the extra thousand dollars a year to keep those decisions between me and my doctors.
The US medical system is a hydra and fixing any one part doesn’t actually solve anything. The entire system needs to be overhauled top to bottom. Switching to a single payer system is just the first step in that process but it’s a necessary one because otherwise the problem is intractable. It’s likely the patent system is going to need to be overhauled at least with regards to medications before it’s fixed as well.