Re: The PPACA Thread Part IV - Repeal & Replace, or Something...
If I may please call for a temporary truce?
We are all primarily in far more agreement than we have acknowledged.
I assume we all favor a vibrant and robust health care sector in which people receive quality care effectively, compassionately, and economically.
All of us are wary and suspicious of the economic power of large health care conglomerates, both in the insurance market (dominated by 4 or 5 companies) and in the consolidation of provider networks (hospital groups buying multiple private practices in a geographic area to centralize the record-keeping and bookkeeping functions, and also gaining monopoly control in large swaths of many states).
We have been using the word "profit" to mean two different things, so that neither of us had a clue what the other was talking about (in a sense).
There is an accounting definition of "profit" that is very misleading, because it is analogous to interest income, just from a different source. Who would deny a lender interest income on the money they lent?
On the other hand, there is a level that is reasonable, and a level beyond that which is reasonable. In lending, there are anti-usury laws; but the only thing that keeps accounting "profits" in the realm of reasonable is competition: if you are making outsize profits, then I'll invest there too, and accept a lower profit than you will because it is still higher than what I am getting now.
None of us trust large insurance companies to be healthcare stewards, I certainly don't. I don't trust direct government involvement either. We need a referee, and if the government is involved directly, then to whom do we appeal when they are wrong?
Look at the medical devices industry right now. Amazing pace of innovation. We know healthcare is too expensive; hundreds of startups that specialize in making one particular part work better, more cheaply, they are thriving.
After putting all those disparate thoughts together, I had an 'aha' moment, just for the sake of pondering: maybe what we really need is a lot more insurance companies! Instead of four or five, how about twelve or fifteen?
