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This is going to precipitate one of two things: If hospitals get federal money for anything they will be required to accept insurance offered on the exchange t

This is going to precipitate one of two things: If hospitals get federal money for anything they will be required to accept insurance offered on the exchange that meet some minimum qualification. At least the two that were blessed as the national options. Or insurance companies will be required to put an offering on the exchange...likely both. Like the states refusing to expand Medicaid and set up their exchanges, the hospitals are hastening the transition to a single payer healthcare system by refusing to play ball.

ams6110 13y ago
Maybe they'll opt out of "single payer" as well.
tunesmith 13y ago
Sometimes I wonder if some genius "systems thinkers" in Washington planned that out as the end game all along. Add in the factor that some states have almost no hospitals, thus the insurance companies have no leverage to lower premiums, which leads to why certain states have very high ACA premiums. Theoretically the free market says that another hospital would pop up to compete on price, but theory ain't practice...
- bcoates 13y ago
  The insurance companies supported and lobbied for the ACA -- which was the only reason it barely passed -- because they thought they were getting a gigantic payday from the employer mandate. With that gone they're doing their best to either kill the law or perhaps lean on it hard enough to get vastly broader subsidies to make it worth their while. The 11-dimensional chess idea that passing a law to destroy the individual insurance market is going to bank-shot into single payer would require an absolutely massive outbreak of corporate and public support that really doesn't have any reason to appear.
  - clavalle 13y ago
    It is more like checkers. Limit the moves: Profit is capped. Now profit can only grow through growth in a market that is, by law, fully saturated. That means mergers. Once the field is winnowed down to a few players, government can cry 'monopoly' and regulate it until it is government run in all but name.
- glenra 13y ago
  > Theoretically the free market says that another hospital would pop up to compete on price, but theory ain't practice It is illegal to start a new hospital to compete on price with the existing ones. To open a new hospital, you need permission from the current existing hospitals. If they don't agree that the community you want to do business in is "underserved", you can't get licensed. And yes, that policy is insane, moronic, a source of monopoly rents and probably one of the many reasons health care costs are so out of control. But it's the law. https://en.wikipedia.org/wiki/Certificate_of_need https://en.wikipedia.org/wiki/Certificate_of_need
  - clavalle 13y ago
    Wow. That is the best example of regulatory capture I've ever seen. I love the rationalization: "If there are too many hospitals many hospitals and doctors my recommend unnecessary hospitalization or overcharge existing patients to cover their overhead". Amazing.
    - glenra 13y ago
      Check out some of these documents if you want to get angry: http://www.tennessee.gov/hsda/con_standards.shtml http://www.tennessee.gov/hsda/con_standards.shtml The standard for "Burn Unit" says there can't be more than one burn unit bed for every 225,000 persons and you can't build a new unit unless all the existing ones in the area have >70% annual utilization. So what if your new unit might be MUCH CHEAPER or merely more competent than the current players? Nope. The government isn't allowed to take mere PRICE into consideration in deciding if you can go into business. Or competence, or anything other than expected "need". And your new unit has to have at least 12 beds - operating at a smaller scale than that is apparently illegal. Then the standard for "long term care" facilities says they aren't allowed to plan on using any spare capacity to provide services such as "advanced emergency care". Why not? Because that might lead to "unnecessary duplication". Ugh.
  - tunesmith 13y ago
    The wikipedia page says that it is the state health agencies that determine need. It doesn't say that the surrounding hospitals have to agree or give permission. Do you have a source on that?

ams6110 13y ago

Maybe they'll opt out of "single payer" as well.

tunesmith 13y ago

Sometimes I wonder if some genius "systems thinkers" in Washington planned that out as the end game all along. Add in the factor that some states have almost no hospitals, thus the insurance companies have no leverage to lower premiums, which leads to why certain states have very high ACA premiums. Theoretically the free market says that another hospital would pop up to compete on price, but theory ain't practice...

bcoates 13y ago
The insurance companies supported and lobbied for the ACA -- which was the only reason it barely passed -- because they thought they were getting a gigantic payday from the employer mandate. With that gone they're doing their best to either kill the law or perhaps lean on it hard enough to get vastly broader subsidies to make it worth their while. The 11-dimensional chess idea that passing a law to destroy the individual insurance market is going to bank-shot into single payer would require an absolutely massive outbreak of corporate and public support that really doesn't have any reason to appear.
- clavalle 13y ago
  It is more like checkers. Limit the moves: Profit is capped. Now profit can only grow through growth in a market that is, by law, fully saturated. That means mergers. Once the field is winnowed down to a few players, government can cry 'monopoly' and regulate it until it is government run in all but name.
glenra 13y ago
> Theoretically the free market says that another hospital would pop up to compete on price, but theory ain't practice It is illegal to start a new hospital to compete on price with the existing ones. To open a new hospital, you need permission from the current existing hospitals. If they don't agree that the community you want to do business in is "underserved", you can't get licensed. And yes, that policy is insane, moronic, a source of monopoly rents and probably one of the many reasons health care costs are so out of control. But it's the law. https://en.wikipedia.org/wiki/Certificate_of_need https://en.wikipedia.org/wiki/Certificate_of_need
- clavalle 13y ago
  Wow. That is the best example of regulatory capture I've ever seen. I love the rationalization: "If there are too many hospitals many hospitals and doctors my recommend unnecessary hospitalization or overcharge existing patients to cover their overhead". Amazing.
  - glenra 13y ago
    Check out some of these documents if you want to get angry: http://www.tennessee.gov/hsda/con_standards.shtml http://www.tennessee.gov/hsda/con_standards.shtml The standard for "Burn Unit" says there can't be more than one burn unit bed for every 225,000 persons and you can't build a new unit unless all the existing ones in the area have >70% annual utilization. So what if your new unit might be MUCH CHEAPER or merely more competent than the current players? Nope. The government isn't allowed to take mere PRICE into consideration in deciding if you can go into business. Or competence, or anything other than expected "need". And your new unit has to have at least 12 beds - operating at a smaller scale than that is apparently illegal. Then the standard for "long term care" facilities says they aren't allowed to plan on using any spare capacity to provide services such as "advanced emergency care". Why not? Because that might lead to "unnecessary duplication". Ugh.
- tunesmith 13y ago
  The wikipedia page says that it is the state health agencies that determine need. It doesn't say that the surrounding hospitals have to agree or give permission. Do you have a source on that?