There's a difference between the statements "America has the best health-care system in the world" and "With enough money, you can purchase the best health care in the world in America." But that difference gets run over in political conversations. Sen. John Barrasso, for instance, just mentioned that a Canadian premier recently got heart surgery in Miami. Best health care in the world, baby!
America has about 50 million uninsured people within its borders. Canada has exactly 13 premiers. People should ask themselves a very simple question: Do they think they are likelier to lose their job and fall into the health-care situation of the uninsured or become an influential politician and enjoy the health-care options available to the most powerful people in the world?
If you're a United States senator, America may have the best health-care in the world. But if you're an ordinary person with the same vulnerability to bad luck that we all have, you're better off being in Canada, or France, or Japan, or somewhere that doesn't take your insurance away when Wall Street causes the economy to crash.
Among the main Republican talking points today is that the health-care system needs more competition, and the way to get that competition is to let insurers sell across state lines. Rep. Marcia Blackburn hit this particularly hard: The way to bring down costs, she argued, is to let consumers do the regulation, which means letting them pick insurance sold in other states.
This is nonsense. Selling insurance across state lines doesn't increase competition between insurers, it decreases standards. I live in Washington, D.C. I can choose among many insurers right now. But it's hard to do because the insurance market is poorly organized, and because my employer doesn't give me many choices, and because choosing a different insurer and all new doctors is a pain in the neck. That's why there's fairly little competition in the system.
What I can't do is choose an insurer who abides by Delaware's regulations rather than D.C.'s. Lift that rule and what you have isn't competition driven by consumers, but a regulatory competition to have the laxest regulations so you have the most insurance jobs in your state. It's exactly what happened in the credit card market, and it's why a bipartisan majority voted to impose new federal regulations on credit card companies last year.
Competition only flourishes in an environment of effective information. When you make the regulation less dependable, you make the product less dependable, which means you remove necessary information from the system and make it harder for individuals to figure out how to make good decisions. If I hear a lot of horror stories about people buying insurance that unexpectedly abandons them when they get sick, I'll be less likely to try and change mine if I'm dissatisfied with it, as I can't be confident that my next carrier will treat me better.
The major step forward for competition is the exchanges, which have regulators making sure the insurance is good enough to deserve the name; which allow consumers to rate the plans; which force the plans to offer standardized information so they easy to compare; which provide a large numbers of plans to choose from; which makes it easier to shop for your insurance in one place; and so on. Yet Blackburn didn't make mention of them. Competition is a good idea. But there's precious little Republican enthusiasm for the policies that would actually promote it.