It seems to me that in health care, competition is effective only when there is a single-payer system in which a transparent (at least compared to private businesses) public entity negotiates with suppliers, doctors, and hospitals for prices. Otherwise, competition usually means locking up a monopoly or cutting corners to meet the demands of insurance reimbursement rates.

Competition in bidding to supply the health-care goods and services to the large risk pool in a single-payer system keeps prices down. The Veterans Administration pays about 40 percent less for drugs and equipment, and Medicare costs have grown much more slowly than with private insurers.

Where a patient can go to any doctor, doctors have to compete for patients based on patient satisfaction. This helps boost quality of care without the nonsense of artificial measures of quality around which loopholes are often found.

We need fundamental change in our health-care system to an improved (no deductible or copay, expanded benefits) Medicare for everyone. Health care should be treated as a utility. Everyone needs it, like gas, electricity and water, and having multiple insurers and plans just drives up costs without adding value.


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