Friday, November 6, 2009

Insurance Across State Lines Won't Work

So says me in today's Raleigh News and Observer. Here is the New Yorker article in which Atul Gawande made McAllen, Texas the most famous medical market in America. The folks at Dartmouth have been analyzing 'practice patterns' or variations in medical care for many years. Here is a link to their web site. Buy insurance across state lines is a great political tag just won't work.


  1. I think you overstate the case against interstate sales of insurance. My whole argument is at

  2. Hey Joe:
    I agree that insurance companies can set up networks in another state, negotiate payment rates and sell insurance. But they can do that now. Even if you totally dergulated health insurance and made one set of federal rules (or no rules) practice patterns will still make this quite hard. It would likely just be open season for cherry picking. It would also likely lead us further and further away from health insurance as insurance (understandable out of pocket risks early on, but then a clear point at which you pay no more). If you dereg I suspect it goes the other way....high deductible with bad cover if you actually get sick. I of course don't have a crystal ball.

  3. Don,
    I think health insurance as it exists now is pretty far from being insurance. Deregulation in other industries has let to more competitors who provided better services to more people for less money. Deregulation in health insurance should be no different. It's all about competition.

  4. agree health insurance gotten away from insurance. With Duke's plan, pretty hard to figure what your out of pocket risk actually is. I would do this if I were king (of course I am not):

    If you had a guarantee out of pocket max like this, I'd sign up for the dereg and comp on the insurance underneath. Key is everyone buy with after tax dollars.