What Health Care "Choices" Are They Talking About?

Cross-posted from dKos with permission of author, JDWolverton.

It happened again this morning. Some talking head on CNN was talking about making sure consumers had adequate choice in health care. What the heck was he talking about? I don't have a lot of choices when it comes to "choosing" my health insurance. ...and I don't have a lot to say about what my doctor recommends for me.

My choice for health insurance is either

  • Take my company's plan
  • Take my spouse's company's plan
  • Go out on the individual market which offers less coverage at a higher price
  • Go bare and pray we don't get sick

Similarly, my choice of health care treatment is

  • Select and pay the balance (after my insurance pays) for the treatment my physician orders.
  • Cajole my physician into ordering a treatment my insurance company allows that will most likely be less effective or the doctor would have ordered it in the first place.
  • Go against physician advice and skimp on care or skip care.
  • Pay the mortgage, car payment, electric bill or skip on food or get health care.

This "choice" meme is particularly irritating to anyone who has faced these "choices".


Like anyone in the U.S. has any real choices when it comes to health care. The choice comes down to pay up or screw you you're screwed.

We're past the niceties of the health care reform arguments. We need to be clear in what we are saying.

Congress. If you plan to pass a health care reform bill without a strong Public Option that competes with private insurance, you might as well pass a health care bailout bill. It would be more honest.

We have studies that show that the health insurance market is a near monopoly.

Two recent studies conclude that many states — most of them ones in which a Blues plan is the market leader — lack competition in the health insurance market, thereby allowing health plans to raise premiums as they see fit.

HCAN's study uses enrollment data collected by the American Medical Association (AMA) to show that in many states, one or two health plans have a dominant market share in terms of enrollment. The study contends that in such states insurers can set premium rates as they please, and it takes particular aim at the growth of profits among for-profit insurers between 2000 and 2007.

Please note these are confirmation studies. These are reproductions of data gathered in 2006.

The study also shows that in 166 of 294 metropolitan areas, or 56%, a single insurer controls more than half the business in health maintenance organization (HMO) and preferred provider networks (PPO) underwriting.

I really don't know why Congress is against single payer insurance, because we have de facto single payer in over 50% of the market place. The real issue with this power is that not only do health insurers have a corner on the number of enrollees. They also control how much physicians and hospitals are paid for the services and reap profits according to Wall Street dictates.

Critics say that carriers are not only creating monopolies and oligopolies in many regions, they also control the other side of the equation in what is known as monopsony power. That means in addition to having the most enrollees, they're also the biggest purchasers of health care and can dictate prices and coverage terms.

It also makes it harder for new carriers to emerge as pricing already has been set by the dominant carrier.

What drives the monopolies? Aquisitions and mergers. It should come as no surprise the Bush administration's DOJ did a poor job of enforcing antitrust regulations, but will Obama's administration do a better job? Is there enough of a call to monitor and regulate these acquisitions and mergers? I think not. These mergers are not in the public's interest.

Contrary to claims of greater efficiencies and lower costs, consolidation in the health insurance industry, in fact, has been shown to raise premiums and decreased patient access to care.

So why is Congress hell bent on preserving our current "choices" in health care?  

They think we can be hornswoggled.

It's up to us to point out the errors of their health care reform plan.

It's important that we point out the falsehood of the current "choice" meme.

  1. Over 50% of the market is controlled by 1 or 2 health insurance plans per MSA.
  2. The mergers and acquisitions in the health insurance market has led to increased costs to the consumer instead of the promised reductions in costs due to Economies of Scale.
  3. The Public Option is a choice 76% of us want to be able to choose.
  4. Too many markets have been consolidated to monopoly or oligarchy with the apparent blessing of the DOJ as they haven't done any antitrust action on health insurers.

Here's the link to Act Blue's health care heros and the health care whip tool.

Here's the front page to the House of Representatives and Senate. You can use the front pages to find your representative and use the main number, (202) 224-3121 to be transferred directly to any Senator or Representative's office.

No votes yet


I have no health insurance at all.

But I manage my my medications cost by ordering at

International Drug Mart. It is an online pharmacy.