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Politics : View from the Center and Left -- Ignore unavailable to you. Want to Upgrade?

To: JohnM who wrote (131635)	2/26/2010 5:44:21 PM
From: Lane3	Read Replies (1) \| Respond to of 541337

Definitely lost on this one. Both the health industry and the healthcare insurance industry remain private but regulated. I have been having a discussion on another thread about the size of government and government functions vs market functions. The question keeps intruding. There are a lot of mixed relationships out there but I can't help trying to sort them out. Having worked with such organizational and authority issues, I look at such things instinctively. I picture myself writing the functional statements, delegations of authority, etc. I don't think that "private but regulated" adequately describes it. The toy industry is private but regulated. Medicare providers, not so much. The government has a variety of relationships with the business sector. One of them is regulation, as we discussed. In that case the business is privately owned and operated. The regulation is there to put certain legal constraints on the company in the best interests of the public/customers. Another kind of relationship the government has with the businesses is a contractual one. As much federal work has been outsourced, for example, what used to be an employer/employee relationship turned into a government/contractor relationship. Different paradigm. In that case most people think of the contractor as the private sector but the functionality is still governmental, not private. The government is just using contractor employees rather than regular employees to do the work. Bear with me. If you look at, say, the relationship between Medicare and it's providers you would think of the providers as typical businesses and they are to a large extent but not entirely. In some ways they function as contractors/contract employees. The government authorizes them to provide service to patients, specifies in some cases how that service may be provided, and pays a contract price (much like a fixed-price contract except that the provider doesn't get to negotiate the price). I would not call that relationship a regulatory one, certainly not a purely regulatory one. I think it's more like a contractor relationship although it has elements of both. When government has a relationship with a contractor, the work done by the contractor is government work, not private work even though performed by the private sector. You seem to think that this rather weak form of government regulation is the same as the British form of healthcare. It's not; and not even close. What I think is not that it's a weak form of regulation but shifted from regulation to a contract employee relationship. If you look at the regulation of doctors' offices, for example, the "regulation" looks less like constraints on the private sector in the interests of the public than specifications in a contract with specifications on work and how to get paid for each piece of work. Unlike the British system, providers own their businesses but the relationship is a lot more like a contract employee one than it is like regulation of, say, smokestacks or banks. You say "not even close" but I say "closer than you think." Providers in the UK are mostly employees, which is not all that different from contract employees. The provisions of the Senate bill that we were discussing are even less like regulation of the private sector. The insurance companies are told what the content of the policies will be. Mostly they just process sign-ups and claims according to schedule, rather like CMS with Medicare. The insurance companies are privately owned and staffed but they look a lot like the contractors who process Medicare claims. I don't see how heavily regulated, private health insurance has harmed the French, the Germans, or the Swiss. No don't there are more cases. The Swiss providers are further into the private sector than are Medicare providers.