Health insurers near monopoly control of most markets

Image by Steve Rhodes via Flickr

I thought I understood why insurance companies were the main threats to a “public option.” It’s easy.  Their overhead—exec salaries, advertising, political lobbying, etc.—averages 31%.  Medicare’s overhead is 1%.  No duh they don’t want to compete.

Today, I found out there’s another reason:  they mostly don’t even compete against each other. Consumers in 94% of America’s insurance markets buy their health insurance from near-monopolies that dominate their region.  The Bigs don’t want to avoid public competition, they want to avoid any competition.

And what happens when profit-makers don’t have to compete? You know what.

Premiums have risen 87% over the last six years, while profits at the ten Bigs rose 428%.  Wait a minute: If your insurer’s profit is up 400%, why are your premiums rising so fast?

So, on with the debate:  Sen. Richard Shelby (R-AL), speaking on Fox News, defended the insurance company position, saying a public option would “destroy the marketplace for health care.”

But TPM today covered a report by Health Care for America Now, saying:

clipped from tpmmuckraker.talkingpointsmemo.com [T]he notion that most American consumers enjoy anything like a competitive marketplace for health care is flatly false. […] The report … uses data compiled by the American Medical Association to show that 94 percent of the country’s insurance markets are defined as “highly concentrated,” according to Justice Department guidelines. Predictably, that’s led to skyrocketing costs for patients, and monster profits for the big health insurers. Premiums have gone up over the past six years by more than 87 percent, on average, while profits at ten of the largest publicly traded health insurance companies rose 428 percent from 2000 to 2007. HCAN describes the situation as “a market failure where a small number of large companies use their concentrated power to control premium levels, benefit packages, and provider payments…” [O]ne former top Federal Trade Commission official … has sent a letter to the Justice Department’s Antitrust Division, asking for an investigation into the health insurance marketplace.

And maybe that’s why millions of your excess insurance premium dollars are being spent on defeating a public option, rather than on reducing your premium.

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Ask the powerful five questions

Like wealth of most kinds, power seems to make people smaller. Washington, D.C., (for example) is not known for its champions of selfless idealism.  Yet many of those same people came into politics with a hope of doing good.  I suspect it is a very hard place from which to keep focused on justice.

Tony Benn, Labour‘s second-longest serving member of parliament in the U.K., proposes five plain-spoken questions:

Those might raise a fuss, eh? (h/t Homeyra!)

Here’s another Benn thought-provoker:

“If you talk about a global answer to a global crisis, you can’t just talk about the movement of capital, now we are told all the time we must not have protectionism, but the most powerful protectionism in the world is immigration policy. Capital can move anywhere in the world to boost its profits. But labor can’t move because of the immigration control. Now I am raising huge questions, I recognize that. But if it is legitimate for a big American company to go to Malaysia where the wag[es] are low and triple their profit, why shouldn’t a Malaysian looking for high [wages] just go to America?“

Well?  Immigration as protectionism – now there’s a fresh insight!

Power and Powerlessness (Easter sermon)

Resurrection of the Lord: Easter Day, March 23, 2008

Matthew 28:1-10; Acts 10:34-43; Colossians 3:1-4; Psalm 118:1-2,14-24 (Easter A)

Christ, the Lord Is Risen Today
Alleluia, Alleluia
Our God Reigns
The Wonderful Cross

Matthew 28
Risen from the Dead
After the Sabbath, as the first light of the new week dawned, Mary Magdalene and the other Mary came to keep vigil at the tomb. Suddenly the earth reeled and rocked under their feet as God’s angel came down from heaven, came right up to where they were standing. He rolled back the stone and then sat on it. Shafts of lightning blazed from him. His garments shimmered snow-white. The guards at the tomb were scared to death. They were so frightened, they couldn’t move.

The angel spoke to the women: “There is nothing to fear here.

Refusing control: Jesus’ three temptations

A sermon for the first Sunday in Lent; February 25, 2007
Luke 4:1-13;Romans 10:8-13;Psalm 91:1-2,9-16;Deuteronomy 26:1-11

Music:
Come, Now Is The Time
You Are My All In All
This Is My Father’s World
Be Thou My Vision

Richard Swanson (in Provoking the Gospel of Luke) says if you were from another planet, dropped in, and listened to Christians, you might think they believed in two Gods – a good one and a bad one – whom they call God and Satan. With 1st century Jews, it wasn’t so – Satan was the tester, the accuser. His job was to travel the earth and look for things that weren’t true, weren’t sound, and expose them before God. “Aha! See, God? See?” Think of Job: “Here’s one, God. He isn’t true. He’s just happy because you give him lots of good stuff.”

But Luke’s first readers would never have seen the accuser as anything like God in power. “This is my Father’s world” would have been the attitude – and even “though the wrong seems oft so strong, God is the ruler, yet.”

And so this tempter comes to find what’s unsound in Jesus.

Now again, remember the last thing that happened – what’s the context here? It was Jesus’ baptism, and a voice that said, “You are my Son…” And what’s the tester’s first phrase to Jesus? “If you are the Son of God …”

Perhaps Jesus thought, “Was the voice true? Did I even really hear it? Who am I, really?”

Why hold back on Iran? Here’s why.

A good friend of mine asks an important question regarding President Obama’s low-key response to the Iranian election crisis:

…if things go back to normal isn’t all of the bloodshed-the woman bleeding out in the street for all to see in streaming video-all for nothing? […]

I am trying to be a lover of peace…but it is so hard when people are being killed at the hand of a dictator and watching the most influential man in the free world be silent.

I’m truly glad he asked.  Here is my response:

Image via Wikipedia

1. Though perhaps not well covered by all news sources, Obama has been far from silent. Here are excerpts from his statement on Saturday:

The Iranian government must understand that the world is watching. We mourn each and every innocent life that is lost. We call on the Iranian government to stop all violent and unjust actions against its own people. The universal rights to assembly and free speech must be respected, and the United States stands with all who seek to exercise those rights.

See the whole statement at Obama statement on Iran violence.

2. Those who understand Iran well are begging the USA not to go further than that. Even conservative Morning Joe agrees:

SCARBOROUGH: All we would do is undermine those people in the street, who the second that they are attached to the United States of America, the country after all that’s been known in Iran as the great Satan since 1979, we will undermine their cause … It’s so shortsighted I find it stunning. […]

What would John McCain and Lindsey Graham specifically have the president say? All of those people that are emailing in and telling me that I’m being liberal? Oh really? I’m being liberal? No I think it’s called restraint. Showing a little bit of restraint. Looking at the battlefield in front of you and not just running up Pickett’s Charge and getting gunned down. If you want to feel good about yourself — and you can only feel good about yourself by screaming about the evils of Iran — fine do that. But our leaders in Washington don’t need to do that because people will be routed in the street the second they are identified with the United States of America.

3. Here’s the core issue: American support is the kiss of death for reform movements in countries like Iran. Ever since the CIA took down the Iranian democracy in 1953, the parties in power now have seen anything American as a threat to national security. If the President says one word that can be construed to suggest that the USA is behind the reformers, the Iranian government will believe it has a national security reason for radical, brutal action against them. It will give them an excuse to a) annihilate the movement (the killing could become far worse than it is now), and b) ignore the reformer’s issues and write them off as foreign-inspired nonsense.

Here’s how the President said it on CBS’s Early Show yesterday:

In an interview with CBS’ Early Show this morning, Obama responded similarly to Scarborough, saying the U.S. has to guard against being used as a scapegoat by the Iranian regime:

“The last thing that I want to do,” the president said, “is to have the United States be a foil for — those forces inside Iran who would love nothing better than to make this an argument about the United States. That’s what they do. That’s what we’ve already seen. We shouldn’t be playing into that. There should be no distractions from the fact that the — Iranian people are seeking to — let their voices be heard.”

McCain and Graham are growing increasingly isolated, as Republicans in Congress and conservatives in the media endorse Obama’s measured response.

4. It’s a deadly game. Obama could win himself a lot of public support by really giving it to Iran. But, thank God, he knows the world well enough to resist the temptation to do that.

For some reason, American foreign policy has often been tone-deaf, and almost intentionally so. Those who ridicule Obama for the hugely positive receptions he gets in Europe often say, “Who cares what other nations think?” And that becomes an excuse for deep ignorance of the impact of our actions on other nations. We get starry-eyed about our own goodness, and our foreign policy becomes one of doing what feels good to us.

As a result, we often make situations worse rather than better. In this case, understanding Iran means walking more softly rather than letting it all hang out. Here are some historical reasons why:

5. The Bush Administration accidentally torpedoed the reform movement in 2005. A reformer, either Rafsanjani, was the president before Ahmadinejad. He offered to open up relations with the USA, and to try to work together on Iraq, even writing a letter to Bush to propose it.

Bush, ever un-aware of the impact of his actions, saw Iran as an enemy and snubbed the letter (not even responding, I believe). Iranians knew it, blamed their President for having no clout with the West, and replaced the reform-minded President with hard-liner Ahmadinejad. Bye-bye reform, thank you USA.

6. And that is typical of the history of US policy toward Iran. Heavy-handed moves toward control, starting even prior to 1953 (in a move to force Iran to sell us oil at, perhaps, 10% of its value), are what Iranians expect from us. “Here they go again” is what they guard against. We’ve made that bed, and now we lie in it, having virtually disabled ourselves.

Image by Stephen Downes via Flickr

We see America as good. They see America as the country that robbed them of democracy and set up a corrupt puppet dictatorship and trained merciless, dreaded secret police who killed thousands, and is likely waiting for a chance to do it again.  Freedom and democracy, to the revolutionaries of just 30 years ago, meant getting rid of US influence.

The only way to improve that is to allow Iranians to make their own way until they can trust the USA again. It will take a long time and a lot of patience, for we’ve spent half a century degrading ourselves there.  But I think we might be surprised what a little worldwide credibility could accomplish.

Thanks for asking!

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