re: #251 karmic_inquisitor

Look - my sister who has been a trauma surgeon in San Jose for almost 20 years (with a 4 year stint being the chief surgeon at a midwestern hospital) just quit. She was an Obama supporter, gave, volunteered, went to an inaugural ball - the works. She quit because the situation has worsened and she sees no end to a shrinking income that started shrinking about 10 years ago.

She went to the midwest because the insurers/payers were not taking as much as in the SF bay area (where rates are among the highest in the country, yet practitioner incomes are shrinking). then the fix started there too.

Now she will make twice as much money auditing hospitals. That’s right - she joined the bean counters and will make more money than anyone in the operating room (except maybe the top nurses - the nurses union in the SF bay area is quite strong).

When you segment the market and shrink both the resource and risk pools you create room for the oligopolists to do their thing. the point of going interstate is to spread both pools. Practitioners LIKE having more than one payer - there is a chance they might get paid better by one than another. When you force a market to have few payers who have an incentive to drive up costs and where the consumer will not walk away from a higher priced product then you get what we have.

And people are leaving the field in these markets - like silicon valley, where car accident victims will now get lower quality care because the experienced trauma surgeons can’t make a living (my sister has a mortgage on a 1200 square foot house and drives a 12 year old car and has no retirement savings - she used to live better 10 years ago).

Ezra Klein et al are free to spit out whatever talking points they want to rationalize the “reform” package we want and it is interesting to see the left defend it now that they own it, but the plain fact is that we have all made the situation worse. It has nothing to do with the cost of the providers - it has to do with the protection afforded the payers and the pharmas to get a deal done.

We have one option left - single payer.

A less radical and intrusive way to avoid a balkanized market and avoid the race to the bottom would be to get rid of the state regulators and substitute a national regulator. One set of rules, one marketplace. Everyone can market everywhere, subject to their ability to deliver the product and comply with the rules. (Which is not a trivial restriction: setting up provider networks isn’t a simple task.)