Competition Hasn’t Worked in Health Care

Back in December, Ezra Klein had a really good post, Competition hasn’t worked in health care.

"Republicans and Democrats have the same problem with the Congressional Budget Office: it refuses to score competition between health-care plans as a surefire way to lower the cost of health care.

This annoyed Democrats during the health-care reform debate, as it meant the Affordable Care Act didn’t get any credit for the competition it would foster on its exchanges. It’s annoying Republicans now, as it means their Medicare-reform plans need to impose blunt spending caps if the CBO to certify them as deficit reducing.

But the CBO is in the right here: No matter how much sense competition makes in theory, no matter how obvious it is that it will drive down the price of health care, the fact is that it keeps failing when we put it into practice."

Kevin Drum added, Healthcare and the Free Market. "This actually seems unlikely to me. Companies like Aetna and Blue Cross are plenty big enough to negotiate favorable prices from healthcare providers. And they do. I suspect the dynamic driving higher costs in the private sector actually lies mostly with private employers, who compete with each other to keep their workers satisfied. This means that they help drive costs up, not down, and healthcare insurers respond to this. What's more, employers can always make up for higher premiums with smaller wage increases, which gives them less incentive to pay a lot of attention to healthcare costs in the first place. As long as their total compensation costs stay within reason, they don't much care whether it's going out in wages or in benefits. (In fact, since healthcare benefits aren't subject to income tax, they actually have a small incentive1 to increase benefits at the expense of wages.)

So I guess I wouldn't give Medicare quite such huge props for controlling costs. There's probably less there than meets the eye. Still, even if the numbers aren't as impressive as Tyson suggests, there's not much question that private healthcare providers have never done better at controlling costs than Medicare, and have almost certainly done at least a little worse. This doesn't bode well for the notion that unleashing the forces of free market competition will do much good for Medicare."