"I'm stunned that people that hate monopolies seem to be fine with a government-run one. In all cases, innovation stops and quality declines because nobody real

"I'm stunned that people that hate monopolies seem to be fine with a government-run one. In all cases, innovation stops and quality declines because nobody really has a choice." In all cases where there is no longer an intrinsic or external incentives to maintain quality or innovate, sure, those things tend to drop off. A private monopoly has no near-term financial incentives, and are left with whatever intrinsic motivation the owners may have. This isn't true of a public monopoly run by a democratic government, however -- there's always incentives there, even if they aren't market incentives. And speaking of incentives, it's a real mistake to assume that the same kinds that often work to produce effective products/services in other markets are at work in insurance. In most cases, vendors make money the more operational efficiency they have and the more utility people derive from what they're offering. In insurance, there are issues of operational efficiency, of course, but they're limited and quite secondary to the fact that insurance pools do better the less participants need them. The incentives that insurers have are to screen and pick their customers from among those as likely as possible to get the least utility out of the product. And, of course, to provide the minimally acceptable utility. So you end up with a product where the vendor has strong incentives not to sell it to those who need it most, and to try and aggressively market to groups who are statistically most likely to need it the least (say, those who are usually able to go into work five days a week). When the natural incentives for a given product don't line up right, no amount of market freedom is going to mean a better product. If there's going to be insurance products that are truly helpful for most everyone who needs them, heavy regulation and public monopolies are pretty much the only option. Under such circumstances, even people who don't otherwise like monopolies might well get behind a public one.