We need to separate health care from health insurance. And we probably need to separate “preventative and general” health care from “catastrophic” health care. We have to do that with regulation, since it is the insurance companies who perpetrated the crime of packaging on us in the first place. And we need to reflect the cost of these three items directly to the consumer, instead of hiding it in tax benefits for mega-employers who buy cadillac plans from defrauding “actuaries.”

We probably need to regulate this industry as if it were a monopoly. Once upon a time, we were spread out all across this country, and that allowed for local communities to directly regulate the cost of care and administration, simply through their neighborly influence. But now most of us are concentrated in urban centers, and those that are not are spread far and wide in the smallest of groups. We need large, centralized entities to do that administration. It’s probably true that this administrative component has perfect economies of scale, meaning that having a single entity is the most efficient way. It’s also definitely true that medical technology has changed drastically, wonder drugs, micro- and nano-surgery, and imaging advances being the most well known. These technologies are highly capital intensive. Perfect economies of scale and capital intensive industries lead naturally to monopolies, which require regulation.

I haven’t read the health care bill. It’s 2000 pages, so I am sure it is full of concessions and full of pork. But it contains 2 critical tenets, requirements it makes of the insurance companies. They are universal access regardless of context, and limiting profits and administrative and marketing costs to 15% of revenues. That is exactly what a regulated monopoly would look like. It’s what utilities look like now.

Take a close look at what the insurance companies are fighting in that bill, and you’ll see that it’s these 2 tenets. And take a close look at the politicians who want to repeal these aspects of the bill. These Corporatists want to replace them with “so-called free market” ideas that actually take away what little leverage consumers still have, while giving insurance, pharmaceutical, and hospital oligopolies total control of the market.