1. I agree that BCBS is a monopoly but I see that as a product of the market, (having participated in more than one competing plan). I have had insurance outside state lines. It didn’t help much and gave me less recourse when the plan abruptly folded. The closest analogy that comes to mind is out-of-state sub-prime lenders holding loans originated in-state but now exempt from state remedies.

2. Agreed

3. Problematic: I don’t agree that HSAs are consumer-driven models. I think they are driven by people who want to be closer to their cash than their health. Even if I agreed with the premise I would agree with the “Viagra” observation, but not with the “sniffles”. The “working wounded” are more a danger to other people (co-workers, family members, children’s classmates and their families) than they are to themselves. People should see a doctor, even a doc-in-the-box or nurse practitioner. Some serious problems present initially as “sniffles” and should be intercepted early (especially for pre-natal women).

4. Couldn’t disagree more. (See Max Borders above: “why aren’t you blaming Medicaid for not getting eligible people into the program?:”) Adding children to a pool from Medicaid may decrease average costs of individual premiums but will increase the cost of of family insurance, resulting in fewer children and adults insured. (Also divorce rates, custody and parental issues make coverage and continuity complicated for many kids).

5. I would tend to agree but I do think drug companies should recoup their research investment. I don’t have a major problem with the 7 years but I do have a problem with the proliferation of delivery mechanisms that artificially extend patent protection beyond 7 years. (ie injected, snorted, inhaled, sublingual, skin patch etc.)

One important of increased infant mortality is the increase in premature births. Technology can prolong life without necessarily improving it. The same technology that reduces infant mortality may indeed be raising it simultaneously. This is a separate discussion.

I think that the health of the mother is critical. Most Western European countries have lower infant mortality rates than the US. They must be doing something right that we can learn from.

Also, clarify your pharmaceutical patent ideas. I have some ideas there myself.

BTW, Steve, if it will help my traffic, I’ll be more hyperbolic and ribticklin’.

That said – and to your request, Greg – there are positive free-market measures that can be taken to improve access to and quality of care:

1. Let people buy health insurance in other states to kill the BCBS monopoly and let people choose the kinds of policies they want (rather than foisting them on people with costly mandates.)
2. Move away from employer-based insurance created by the taxcode, which distorts markets and limits competition.
3. Move to consumer-driven models like HSAs that discourage rich people from charging Viagra to the pool, and everyone from going to MDs for sniffles. (In short, mitigate the expense account effect.)
4. Stop expanding children’s Medicaid which makes healthcare less affordable for everyone else, including the less affluent, lower middle class. Children are lower risk and cheap to insure, so removing them from the pool drives up premiums (which in turn causes people to self insure).
5. Reduce the 7 year protectionism of generics via patents to 5 years to shorten the window for access to cheaper meds.

These are just a few. I’ve got loads of ‘em.

If you have something constructive to contribute on the subject of reducing infant mortality and how the free-market could help then please do share.

http://redclaycitizen.typepad.com/redclay/2007/09/healthcare-half.html

Your churning out this mendacious narrative over and over again doesn’t help improve healthcare. We need more freedom, not less.

If you’re going to write like a Soviet apparatchik you’re going to be taken for one.