Yes, Ezra, competition would reduce the extent to which insurance companies gouge their customers under a system of mandated insurance. But mandated insurance would provide enormous incentives for collusion and monopolization, so much so that it would almost be required to merge under simple fiduciary responsibility. And remember, they aren't going to be subject to anti-trust laws. That got taken out.
He also points out the "cadillac tax" and exchange regulators as agents who could keep prices down:
But the exchanges actually have a fail-safe solution, too. Rewind the tape to BCBS's decision to jack up premiums. Imagine that BCBS insures 420,000 people in California's exchange. As directed by law, they duly submit a notice to the Exchange Board saying they're increasing premiums. The exchange sends a letter back noting that underlying health-care trends don't justify that increase, which they're allowed to do under the law. BCBS says it doesn't care. The exchange, which doesn't much feel like being bullied, says fine, you're decertified. BCBS loses more than 400,000 customers, and has to reapply the next year.Two problems with that. First, there is no definition here on what is or isn't "justified". I suppose the exchanges will have to determine that for themselves. If the exchanges are staffed by anybody but the most dedicated public servants the Union has to offer, some of them are going to flub that decision; Especially when faced with a regional monopolist with deep mandate-fattened pockets. armies of lobbyists and pet politicians.
And then, of course, there's the excise tax. Jack up your prices enough and suddenly you're paying a 40 percent surtax on the plan you're offering. Now you're way more expensive than the competition, and you're hemorrhaging customers.
Health-care reform isn't creating a monopoly market. There are other industries where people need to patronize some for-profit company. Food, for instance. But if there are a variety of companies competing for customers, monopoly problems don't emerge.
Second, do you honestly think that regulation and punitive taxation is going to deal with this problem? Your Democratic friends have already had their clock cleaned by the Republicans, America is already in this mess because Democrats can't pass legislation that isn't terrible. What the hell makes you think that the regulations and "cadillac taxes" won't get gutted by the Republicans, or even the ConservaDems, between now and 2013?
Especially when the most powerful lobby on the Hill—and it will be after this—is doing everything it can to water down the regulations, which has already been watered down to begin with? There WAS anti-trust reform in the bill. That got taken out, and language allowing these mandated insurers to get out of providing care was inserted in.
There is no reason to think that this process won't continue. There's no reason to believe that the regulations will stand. There is no reason to trust these exchanges to be immune to lobbying. There is no reason to expect the "cadillacs" to stay as they are. There is no reason to believe the lobbyists won't run rampant. There is no reason to believe that the Republicans and ConservaDems will ever improve this exercise in naked corporatism.
It will just get worse.
I'm still waiting for an answer to my question. Is there a bill these people wouldn't support? Is there a line they wouldn't cross? When women's health and safety are sacrificed to get Ben Nelson's vote, is that still not going to convince them that some things are indefensible?
Obviously the Dems are never, ever going to have a line that they won't cross, because they're terrified of the possible consequences. But that's why they supported the Iraq debacle, too, in all its destructive horror. The LieberCare hawks are primarily the "Liberal hawks" of 2002-2003. Have they learned anything? Have they changed at all?
IS there a line?
Edit: I'm wondering whether or not this has less to do with policy and more to do with pride. There are no small number of LieberHawks who have poured a ton of time and effort, now, into defending this crap. Convincing progressives that the bill is actually defensible is one thing: ultimately progressives want to be convinced, because they don't want to believe that they now have to take up rhetorical and political arms against the people that they had worked so hard to elect only last year.
Convincing the "wonks", however, is going to be much harder. (I scarequoted "wonks" because it is insulting to argue that the critics don't understand the legislation, but that's what its supporters insist.) If people like Ezra and Yglesias and Drum turn on the legislation, they're in deep, deep trouble. The Dems will shun them, because the Dems believe that their electoral fortunes will be better if they pass it than if they don't. (They're wrong, but it's a question of belief.) The Washington Establishment will probably shun them, too, because they'll have associated themselves with all those nasty dirty hippies, and irritating pseuds like me and digby and atrios. And progressives probably won't be terribly supportive, either, since this is twice now that they've been yelling at us for speaking Truth to Dems.
It's a hard place to be in. But, remember, we didn't put you in that place. They did.