Until they are pried apart, what is actually is behind the curtain of ‘socialized medicine, medicare-for-all or one payer, is super-high-cost corporate welfare.
There are ideas in here I hadn't encountered, possibly because I haven't concerned myself with them. Most insurers and providers I've used in the last few years feel like some kind of high skilled DMV, and this post helped me make some sense of it (if it's true). Insurers concentrated, then providers concentrated to keep their negotiating powers.
Doctors and hospitals were put on the defensive as insurers merged with one another and forced providers to make price concessions if they wanted to keep their insured patients. Insurers used their increasing monopsony power to put the screws on drug companies and everyone else in the medical supply chain. This explains why, for a brief moment in the 1990s, the nation’s overall health care bill actually declined.
Then came a counter-revolution. Those sixty drug companies combined into ten, hospitals, outpatient facilities, physician practices, labs, and other health care providers began merging vertically and horizontally into giant, integrated, corporate health care platforms that increasingly dominated the supply side of medicine in most of the country. These are ‘life’ platforms that have extended their power by controlling the very marketplace in which customers and suppliers have to do business.
At first it might seem that giving the government that kind of concentrated purchasing power is just what we need to contain the growing monopoly power of hospitals.But what happens when a single payer finds itself negotiating with a single provider?