Really, this is growing tiresome


Do you guys have anything to add that doesn't include a mountain of bitching about the Republicans? Seriously, this shit is old. Old, gentlemen. For fuck's sake.

Just bitching and running in circles. Thousands upon thousands of words that all lead back to "it's the inept Republican's fault". I have fucking had it. Am I making myself understood?

We're rapidly moving to a point where you won't even be able to type "obamacare" in your post without it getting queued up and then never reaching the board. Is that what you guys want? Can I be any fucking clearer?????

quote:

Originally posted by chellim1:
First off, I do not speak for "true conservatives". I don't even know what that term means. I speak only for myself.
Second, I think you over-simplify our discussion...
... are they [conservatives?] proposing something akin to Clinton assuring miners that she would continue to kill their industry?

The questions become very simple for a consumer: Can I get care? Can I get it at a reasonable cost?

In asking you about your view of the "true conservative" position, you did not object to speaking for "true conservatives." With all the yada, yada everywhere, it really comes down to some simple questions.

I asked: "chellim1, is the "true" conservative health care approach to have it all free market without the government setting any threshold for minimum coverage?"

Your Response: "Yes."


You further responded as the issue developed: "Yes, some people would "fall between the cracks" either due to their own incompetence or some disaster beyond their control.
See charity above."

I asked you: "Rather than having a government run system, isn't there room to set minimums and then let the market freely compete as a compromise"?

You responded: "Yes, of course. Life is like that... sometimes we take a stand on principle and sometimes we must compromise."

So, it seemed to me that you may see some role for the government in, at least, a transition.

I am trying to understand just what the people who speak for or see themselves as the "true" conservatives believe should be done.

For some reason the "true" and superior, pure conservative view is having trouble convincing others to join them. Why? The President and many other legislators would like to see something that does not let people fall through the cracks - or so it seems to me.

No conservative that I know wants government-run health care. But, the question is how we should eliminate the way it's run now without telling people, "Too bad, so sad."

As I stated before, philosophy is wonderful but consumers need a policy approach that meets their health care needs.

Para, I was writing when you were posting.

quote:

Originally posted by Tubetone:

Would Berkshire Hathaway rush in to ensure sick people with costly illnesses? Obviously not. Dropping sick people cold turkey into the free market is not something legislators may find acceptable.

BH isn't going to rush in an insure well people, either. Pretty soon, neither will the so-called health insurers.

The problem is that the product is not insurance, but health care. "Policies" required to be offered are not insurance but pre-paid health care.

Insurance is used when a large number are exposed to a risk which will happen to only a relative few. It is impossible to predict which of those will incur the loss. Those few will incur significant loss, but no one else will. The traditional model is fire insurance. Nothing in the health care market really fits an insurance model any more.

The way health care has evolved has resulted in the insurer being on the hook for nearly every health event in an insured's life, doctor visits, treatments, hospitalization, tests, and conditions not ordinarily thought of as injuries caused by intentional conduct, substance abuse, pregnancy, obesity, everything. The insurer must deal with a vast variety of providers, doctors, hospitals, ambulance, paramedics, suppliers, labs, and negotiate prices with each. Each company has a relationship with each supplier of services or products. If that weren't complicated enough, the government, by regulation or direct financial involvement, has extended its strong arm of stupifying complexity throughout the industry.

The inefficiencies in all this are staggering, an earmark of every area government has become involved.

quote:

Originally posted by JALLEN:

quote:

Originally posted by Tubetone:

Would Berkshire Hathaway rush in to ensure sick people with costly illnesses? Obviously not. Dropping sick people cold turkey into the free market is not something legislators may find acceptable.

The problem is that the product is not insurance, but health care. "Policies" required to be offered are not insurance but pre-paid health care.

I was referring to governmental policy in my last post.

Even so, your assessment about insurance policies is worth some thought. We don't have to have a system built on insurance. Maybe some other form of prepay would be better? Oh that would not be popular with the lobby. I've said a number of times that co-ops have produced some excellent results.

My very elderly mother bought into a concierge service that has been working for her even though she has two other lifetime insurance coverages.

Yes, in my opinion, a free market approach, without the government setting any threshold for minimum coverage would be a good thing.
That way, people would buy only as much coverage as they think they need. I next advocated for catastrophic coverage only, preferring to pay most health care bills out of pocket rather than through a third party.

Personal responsibility is the key. I never said anything about bankruptcy, except that it could be avoided by purchasing some affordable coverage, which I believe would be more widely available without the ACA limitations on what is offered. I believe your choices would be better, but they would still be YOUR choices, not the governments.

If people do have a choice in the matter, some people will still choose not to purchase anything, just as some people ride a motorcycle without a helmet and some people continue to smoke despite knowing the risks.

I think co-ops and the concierge service mother bought into are great options. I don't think you have to fear repeal, as long as you are willing to search out your own best options and take some responsibility. After all, it's your health. What could be more important?

quote:

Originally posted by chellim1:
Yes, in my opinion, a free market approach, without the government setting any threshold for minimum coverage would be a good thing.

Yes it would. Cost would be minimized, no or little waste, much more competition, much more choices of coverages.

quote:

After all, it's your health. What could be more important?

That 65" flat screen TV, for one thing. As long as you can get health care free by showing up at some facility, why spend money? Nobody else will buy you that TV you nee, errr, want.

I did some real estate developing in a border town. There is no hospital there, no emergency services, because they have to treat anyone who shows up. This town, on the border across from a huge town of several million in Mexico, can't afford to treat all the thousands of Mexicans who would have to be treated for free.

This isn't a slam against Mexicans. They have next to no care there, and when we or our child needs serious care, what would any of us do? But in the circumstances, it kills health care availability in that town.

This message has been edited. Last edited by: JALLEN,

quote:

Originally posted by chellim1:
I never said anything about bankruptcy, except that it could be avoided by purchasing some affordable coverage, which I believe would be more widely available without the ACA limitations on what is offered.

I asked:
"What did people do before and would again? Bankruptcy - not exactly a market force idea."

To that question, your reply was:
"See above. I would carry a high-deductible catastrophic plan at a reasonable cost and cover my high deductible with my HSA. . . .
Yes, some people would "fall between the cracks" either due to their own incompetence or some disaster beyond their control.
See charity above."

Consequently, the simple repeal and let the market sort it out policy approach seemed to turn a cold heart to many who would be caught in the process.

This may be why a President who says that he wants to ensure that everyone has access to health care and other legislators who have constituents may balk at not having a transitional form.

Why is it not equally incumbent on "true" conservatives to offer some way to keep people from bankruptcy or charity while the government gets out of the health care business?

Is there such a plan or idea out there?

Free Market Care
John Stossel
Townhall.cim
March 29, 2017


President Trump and Paul Ryan tried to improve Obamacare. They failed.

Trump then tweeted, "ObamaCare will explode and we will all get together and piece together a great healthcare plan for THE PEOPLE. Do not worry!"

But I do worry.

Trump is right when he says that Obamacare will explode.

The law mandates benefits and offers subsidies to more people. Insurers must cover things like:

--Birth control.

--Alcohol counseling.

--Depression screening.

--Diet counseling.

--Tobacco use screening.

--Breastfeeding counseling.

Some people want those things, but mandating them for everyone drives up costs. It was folly to pretend it wouldn't.

Insisting that lots of things be paid for by someone else is a recipe for financial explosion.

Medicare works that way, too.

When I first qualified for it, I was amazed to find that no one even mentioned cost. It was just, "Have this test!" "See this doctor!"

I liked it. It's great not to think about costs. But that's why Medicare will explode, too. There's no way that, in its current form, it will be around to fund younger people's care.

Someone else paying changes our behavior. We don't shop around. We don't ask, "Do I really need that test?" "Is there a place where it's cheaper?"

Hospitals and doctors don't try very hard to do things cheaply.

Imagine if you had "grocery insurance." You'd buy expensive foods; supermarkets would never have sales. Everyone would spend more.

Insurance coverage -- third-party payment -- is revered by the media and socialists (redundant?) but is a terrible way to pay for things.

Today, 7 in 8 health care dollars are paid by Medicare, Medicaid or private insurance companies. Because there's no real health care market, costs rose 467 percent over the last three decades.

By contrast, prices fell in the few medical areas not covered by insurance, like plastic surgery and LASIK eye care. Patients shop around, forcing health providers to compete.

The National Center for Policy Analysis found that from 1999 to 2011 the price of traditional LASIK eye surgery dropped from over $2,100 to about $1,700.

Obamacare pretended government controls could accomplish the same thing, but they couldn't.

The sickest people were quickest to sign up. Insurance companies then raised rates to cover their costs. When regulators objected, many insurers just quit Obamacare.

This month Humana announced it'll leave 11 states.

Voters will probably blame Republicans.

Insurance is meant for catastrophic health events, surprises that cost more than most people can afford. That does not include birth control and diet counseling.

The solution is to reduce, not increase, government's control. We should buy medical care the way we buy cars and computers -- with our own money.


Our employers don't pay for our food, clothing and shelter; they shouldn't pay for our health care. They certainly shouldn't get a tax break for buying insurance while individuals don't.

Give tax deductions to people who buy their own high-deductible insurance.

Give tax benefits to medical savings accounts. (Obamacare penalizes them.)

Allow insurers to sell across state lines. Current law forbids that, driving up costs and leaving people with fewer choices.

What about the other "solution" -- Bernie Sanders' proposal of single-payer health care for all? Sanders claims other countries "provide universal health care ... while saving money."

But that's not true.

Well, other countries do spend less. But they get less.

What modern health care they do get, they get because they freeload off our innovation. Our free market provides most of the world's new medical devices and medicines.

Also, "single-payer" care leads to rationing.

Here's a headline from Britain's Daily Mail: "Another NHS horror story from Wales: Dying elderly cancer patient left 'screaming in pain' ... for nine hours."

Britain's official goal is to treat people four months after diagnosis. Four months! That's only the "goal." They don't even meet that standard.

Bernie Sanders' plan has been tried, and it's no cure.

If it were done to meet American expectations, it would be ludicrously expensive. In 2011, clueless progressives in Bernie's home state of Vermont voted in "universal care." But they quickly dumped it when they figured out what it would cost. Didn't Bernie notice?

It's time to have government do less.

Link

Why must subsidies be offered?

Wasn't the old system basically a government safety net for those below a certain income and insurance for those who could afford it or desired it?

Yet, all agreed that prices and costs were too high under that system, too.

If seriously ill middle class+ people or those in need of medical care are left out, the costs will fall. As it boils down, is that really it?

Libertarians and the "true" conservatives have a chance to win people to their philosophies and resulting policies.

quote:

Originally posted by joel9507:

quote:

Originally posted by Redford1970:
I'm saying that increased competition has little, or no potential for lowering prices in any significant way IF the road to competition is crossing State lines where previously prohibited.

? Not sure I follow.

Is the gist of your assertion an assumption that increased competition in health insurance would have no effect on prices, or is it an assumption that removing state barriers would not cause said increased competition?

Insurance is regulated at a state level. Each plan is different in each state, even if it has the same name. I had to be licensed and appointed in every state I sold insurance in (13 of them). The states insurance commission has say over what's allowed and not. I am unsure of the federal law that actually prevents sale of insurance across state lines, but the practicality of getting all states to agree on coverages, reserves, policy wording, rates, etc. would be impossible. Do you think it's fair to charge the person in Sarasota FL the same as the one in the Upper East Side of Manhattan? Think doctors charge/get paid the same in both locations? How about the cost of land and construction for both locations?

Auto insurance was mentioned in this thread. It is marketed across the country, but each states plans vary. Check out this link just determining who was at fault and which company pays for an accident can be confusing.

You don't need bigger pools to underwrite, you need homogeneous pools.

quote:

Originally posted by joel9507:

quote:

Originally posted by Redford1970:
I'm saying that increased competition has little, or no potential for lowering prices in any significant way IF the road to competition is crossing State lines where previously prohibited.

? Not sure I follow.


Is the gist of your assertion an assumption that increased competition in health insurance would have no effect on prices, or is it an assumption that removing state barriers would not cause said increased competg individual pition?

I have repeatedly addressed the myth that simply allowing marketing of plans across State lines is a money saver. A couple of posters have bought this myth. You won't get much more competition because carriers understand pricing. Even with added competition, prices won't come down because 85% of the price comes from CLAIMS and the cost of CLAIMS doesn't change because the paper is written by a carrier in another State.

ALL healthcare is local. Hospitals and Doctors don't compete across State lines. Using the same cost of parts and labor gets you zero competition. Carriers aren't going to give up their meager profit margin of 3%.

quote:

You don't need bigger pools to underwrite, you need homogeneous pools.

Not quite. You don't need a bigger pool, you need a better pool.

You get that by mixing in young and healthy members. The very ones that would rather pay a penalty than buy insurance. Bigger becomes incidental.

Ask your self, if a pool is averaging $1.20 in claims for every premium dollar, does adding MORE members at $1.20 of claims and still collecting $1.00 of premium solve any problem? That is both bigger and homogeneous.

Add a bunch of members whose claim cost is $0.60 for every premium dollar and you lower the unit cost and eliminate a rate hike. It isn't where your new added members live (that crossing State lines myth), it's what their claim cost is and the mix of low claim cost members to high claim cost members.

quote:

Originally posted by Sig209:

quote:

Originally posted by stoic-one:

quote:

Originally posted by MNSIG:

quote:

Originally posted by chellim1: simple reforms like allowing health insurance to be sold across state lines?

I know very little about the way insurance companies work, but hear this all the time. What is it that makes selling across state lines such an advantage? Don't most companies have a presence in multiple states already?

Increased pricing competition.

This.

As I understand it-

You see it from time to time where insurance companies petition the state insurance commission - it happens pretty much annually - to be able to raise prices.

They get approval from the insurance commissioner to raise prices 4.2% or whatever and - miraculously - they all raise prices 4.2%.

You have no choice but to buy a plan offered through your state. What if you could buy a plan elsewhere that was cheaper and had the coverage you wanted?? That would be great.

So there are many insurance companies - BCBS, Aetna, Kaiser, Humana, etc that offer insurance in many states - but what they offer in individual State A vs State B and the price varies greatly.

--------------------------------

The price variations reflect the CLAIM COST. All healthcare is delivered locally. Hospitals don't compete with other hospitals across State lines, neither do doctors and , yes, I have heard of all the exceptions, organ transplant centers and places like Cleveland Clinic vs. Mayo.

This is a myth...even if John Stossel doesn't understand it.

As for the characterization of how Insurance Commissioners set rates? LOL.

As a minor aside, look up how many BCBS Plans there are in the Country, the majority are independent companies.

quote:

Originally posted by Redford1970:

quote:

You don't need bigger pools to underwrite, you need homogeneous pools.

Not quite. You don't need a bigger pool, you need a better pool.

You get that by mixing in young and healthy members. The very ones that would rather pay a penalty than buy insurance. Bigger becomes incidental.

Ask your self, if a pool is averaging $1.20 in claims for every premium dollar, does adding MORE members at $1.20 of claims and still collecting $1.00 of premium solve any problem? That is both bigger and homogeneous.

Add a bunch of members whose claim cost is $0.60 for every premium dollar and you lower the unit cost and eliminate a rate hike. It isn't where your new added members live (that crossing State lines myth), it's what their claim cost is and the mix of low claim cost members to high claim cost members.

You are correct. My last comment while factual does not have anything to do with costs. In order to underwrite you need to be able to predict your claims. With a large enough group with similar claims experience you can correctly determine the premium to charge.

The only bearing this really has on the conversation is adverse selection. The companies are underwriting assuming that people would sign up for and keep the plans. What instead was happening is only a person with a current need for the policies were signing up skewing the claims experience higher than expected, thus causing the premiums to constantly rise.

You are also correct in that it doesn't even need to be homogeneous, it just needs to be predictable. Homogeneous only matters for assigning a risk to the individual insured. Smoker, male/female, diabetes, etc.

quote:

Originally posted by Tubetone:
Why must subsidies be offered?

Good question? Why?
And what about refundable tax credits to people who don't pay taxes?

quote:

Wasn't the old system basically a government safety net for those below a certain income and insurance for those who could afford it or desired it?
Yet, all agreed that prices and costs were too high under that system, too.

We haven't had a free market system since the 1940's when FDR and Congress (in their infinite wisdom) linked health insurance to employment. That began to destroy the individual market.
Medicare, Medicaid, Tri-care and the VA + the employer deductibility of health insurance already had most people on some sort of government subsidy.

quote:

If seriously ill middle class people or those in need of medical care are left out, the costs will fall. As it boils down, is that really it?

What does that even mean?
Why do you keep saying stuff like "Too bad, so sad." and "those in need of medical care are left out"
Who wants to leave people out? No one! I just want people to have more choice... and to take some responsibility for the choices they make.
Whose responsibility is it to feed your family? Provide a roof over their head? Are you "left out" if you don't receive food stamps? or section 8 housing?
What is the proper mix of socialism and freedom in your mind?

quote:

Libertarians and the "true" conservatives have a chance to win people to their philosophies and resulting policies.

Really?
If half the people are already reliant upon government for their basic necessities, how do we convince people that they should be self- reliant?

Have you visited this thread?
Why Socialism Is Here To Stay
https://sigforum.com/eve/forums...0601935/m/5310058124

quote:

Originally posted by Redford1970:

quote:

Originally posted by joel9507:

quote:

Originally posted by Redford1970:
I'm saying that increased competition has little, or no potential for lowering prices in any significant way IF the road to competition is crossing State lines where previously prohibited.

? Not sure I follow.


Is the gist of your assertion an assumption that increased competition in health insurance would have no effect on prices, or is it an assumption that removing state barriers would not cause said increased competg individual pition?

I have repeatedly addressed the myth that simply allowing marketing of plans across State lines is a money saver. A couple of posters have bought this myth. You won't get much more competition because carriers understand pricing. Even with added competition, prices won't come down because 85% of the price comes from CLAIMS and the cost of CLAIMS doesn't change because the paper is written by a carrier in another State.

ALL healthcare is local. Hospitals and Doctors don't compete across State lines. Using the same cost of parts and labor gets you zero competition. Carriers aren't going to give up their meager profit margin of 3%.

The assumption that interstate competition requires identical product is not correct. McDonalds competes across the country yet prices to the market: the identical Big Mac is pricier in Manhattan than it is in Topeka. Their menu changes too - Honolulu has spam items on the menu. You don't get more individualistic than building codes, and construction material prices vary strongly by location but there are many large national construction companies - and, yes their prices vary by market. And so on, and so on....

Also, the majority of marketers (100% of the good ones) in all industries understand pricing, and that does not prevent competition. In fact, it is a key aspect of competition.

All you can do is all you can do. There would be no point in removing one's state's barriers if there is a Federal one in place - so let's start with the Federal barriers. Then, everyone in adult-supervision states can work at the state level to remove any barrier there.

Yes, claims is the 'cost of goods sold' here, and reducing them is key to any activity that hopes to bring some sanity to premiums and medical costs. So, yeah, removing barriers - State, as well as Federal - is productive but it is not enough by itself. We need open up a giant can of Adam Smith whoop-ass on medicine.

Economics is not an exact science, but when you look at something as screwed up as the medical industry, you don't have to be a Nobel laureate to know that market forces have been kept far away from it. If you want to see what the market can/could do to medical activities, look at areas that are not tax-deductible and not covered by insurance - where participants are shelling out their own money and where the practitioners know it - cosmetic surgery. Costs have plummeted and quality standards have been kept, if not raised.

Laws have set up a situation where costs are not a factor in an industry, and therefore costs have exploded and consumption has skyrocketed. In essence, tax law and entitlement law has murdered the normal action of the market for medical care. To the extent medical insurance works to invalidate cost as a factor in consumer activity, it's an accessory after the fact.

Cosmetic surgeries are seen as optional.

Medical care is seen as essential, and in many quarters as an obligation a humane society must provide.

quote:

Originally posted by JALLEN:
Cosmetic surgeries are seen as optional.

Medical care is seen as essential, and in many quarters as an obligation a humane society must provide.

Good to see you, Jim!

The point was not that one was better than the other. The point was that where the market is allowed to work, things get efficient and where, for whatever benighted reasons the market is not allowed to work, we get the opposite.

In this case, because it was left alone, the optional stuff got cheaper and better through competition, research, innovation and customers being free to choose. And the 'essential' stuff....well, let's be kind and just say all the angst and attention and effort and legislation and subsidizing and exchange-building has had the exact opposite effect.

quote:

Originally posted by joel9507:

quote:

Originally posted by JALLEN:
Cosmetic surgeries are seen as optional.

Medical care is seen as essential, and in many quarters as an obligation a humane society must provide.

Good to see you, Jim!

The point was not that one was better than the other. The point was that where the market is allowed to work, things get efficient and where, for whatever benighted reasons the market is not allowed to work, we get the opposite.

In this case, because it was left alone, the optional stuff got cheaper and better through competition, research, innovation and customers being free to choose. And the 'essential' stuff....well, let's be kind and just say all the angst and attention and effort and legislation and subsidizing and exchange-building has had the exact opposite effect.

It's good to be seen!

That's the point, but the free market will not be allowed to work for medical care because that is now seen as a duty of society, to provide it regardless of economics.

quote:

Originally posted by joel9507:

quote:

Originally posted by Redford1970:

quote:

Originally posted by joel9507:

quote:

Originally posted by Redford1970:
I'm saying that increased competition has little, or no potential for lowering prices in any significant way IF the road to competition is crossing State lines where previously prohibited.

? Not sure I follow.


Is the gist of your assertion an assumption that increased competition in health insurance would have no effect on prices, or is it an assumption that removing state barriers would not cause said increased competg individual pition?

I have repeatedly addressed the myth that simply allowing marketing of plans across State lines is a money saver. A couple of posters have bought this myth. You won't get much more competition because carriers understand pricing. Even with added competition, prices won't come down because 85% of the price comes from CLAIMS and the cost of CLAIMS doesn't change because the paper is written by a carrier in another State.

ALL healthcare is local. Hospitals and Doctors don't compete across State lines. Using the same cost of parts and labor gets you zero competition. Carriers aren't going to give up their meager profit margin of 3%.

The assumption that interstate competition requires identical product is not correct. McDonalds competes across the country yet prices to the market: the identical Big Mac is pricier in Manhattan than it is in Topeka. Their menu changes too - Honolulu has spam items on the menu. You don't get more individualistic than building codes, and construction material prices vary strongly by location but there are many large national construction companies - and, yes their prices vary by market. And so on, and so on....

Also, the majority of marketers (100% of the good ones) in all industries understand pricing, and that does not prevent competition. In fact, it is a key aspect of competition.

All you can do is all you can do. There would be no point in removing one's state's barriers if there is a Federal one in place - so let's start with the Federal barriers. Then, everyone in adult-supervision states can work at the state level to remove any barrier there.

Yes, claims is the 'cost of goods sold' here, and reducing them is key to any activity that hopes to bring some sanity to premiums and medical costs. So, yeah, removing barriers - State, as well as Federal - is productive but it is not enough by itself. We need open up a giant can of Adam Smith whoop-ass on medicine.

Economics is not an exact science, but when you look at something as screwed up as the medical industry, you don't have to be a Nobel laureate to know that market forces have been kept far away from it. If you want to see what the market can/could do to medical activities, look at areas that are not tax-deductible and not covered by insurance - where participants are shelling out their own money and where the practitioners know it - cosmetic surgery. Costs have plummeted and quality standards have been kept, if not raised.

Laws have set up a situation where costs are not a factor in an industry, and therefore costs have exploded and consumption has skyrocketed. In essence, tax law and entitlement law has murdered the normal action of the market for medical care. To the extent medical insurance works to invalidate cost as a factor in consumer activity, it's an accessory after the fact.

Economics is clearly not an exact science, but actuarial science is pretty close. When I said that carriers understand pricing, I intended to convey that "prices", aka PREMIUMS, are determined by the cost of claims, not processing them, but the actual paid claims. Remember, claims are 85% of premium. Has nothing to do with product in this context. I also meant to convey that carriers will make rational decisions on pricing.

No argument that market forces don't work in the healthcare system as they do in other industries. SOME still work but you have to understand a complex system. The law of Supply and Demand is voided because medical providers are both the creators of demand and they are the supply. Doctors drive how many times you need an office call to cure that infection, skin condition etc. They are creating the demand for their services...and then they supply the services. Hospital doctors order tests and then supply them. There is also little to no competition, BUT this has nothing to do with State lines. This is in no small part because patients have no motivation to shop. If a particular service has zero copay, why care. If the service has a $10 copay regardless of whether a service is $100 or $200, who's gonna care which is chosen. The other reason competition is stifled is the lack of transparency.

Your McDonald example makes my point. First, I am not saying an identical product is a requirement. Its irrelevant. Let's say that McD is not in a State now, entering that State won't lower the cost in the other States. They will pay local beef prices, labor prices, taxes, building costs etc. The local market dictates prices for that market, not the fact they crossed State lines. ALL healthcare is delivered locally. My hospital does not compete with yours. Neither do our Doctors.

You have hit on some truths about our system, but you have just jumped to an erroneous conclusion.

P.S. One big market force which is working is Cost Shifting. As Medicare cuts back reimbursement (thanks to ACA), hospitals, which derive 45-55% of their revenue from Medicare, raise prices to commercially insured patients. They have to in order to keep doors open. Just another way government is driving up prices for the average American not yet on Medicare. This also happens when there is a dominant Blue Plan in the State, They squeeze out too much in their PPO network price agreements, and hospitals and doctors cost shift. The other big market force which still operates is the marginal utility of coverage. At some price point, people stop buying