Aetna CEO Threatened Obamacare Pullout If Feds Opposed Humana Merger

The healthcare system in countries like France, Canada, Germany is much more efficient and provides better healthcare to most of it's citizens than the US healthcare system pre and post obamacare.

https://www.oecd.org/eco/growth/46508904.pdf

http://www.commonwealthfund.org/publications/press-releases/...

different options with respect to coverage, for one

There is no benefit. The benefit is for the legislatures who passed the law. There was no way that we'd get single payer here in the US because our Congress is very much in the pocket of the health care industry. As such, the markets were a compromise measure enacted by congress to make it easier for people to choose health care. Before Obamacare, it was sort of a black box where only HR people could figure out pricing structures and health care providers didn't really compete in any way with each other.

Obamacare did do some good things that needed to be done, but essentially, everything about it was a bandaid intended to kick this shitty system down the road to the next person who had to deal with it. But hey, at least health care companies can't just turn you down because you have Diabetes or are too fat anymore.

#1. This is going to generate useless flame wars, because most people on both sides don't know very basic facts.

#2. Using a private insurance company means you get, in theory, to pick a provider that matches up with your desires on how to determine what is and isn't covered.

> Can anyone succinctly explain the benefits of having a market for private health insurance companies, rather than a single provider of health insurance

For the citizen, none. For the insurance companies, they get forced signups.

> Does the lack of a large private insurance market in countries with government-provided health insurance cause lots of inefficiencies and waste?

The US spends the most of any nation on health care. The US is the only western nation with increasing infant and maternal mortality rates.

The main issue with healthcare in the u.s. actually has to do with Medicare, Medicaid, and social security.

All of the state options pay only ~10% of what they are billed no matter how large the bill (there is also usually a cap). This forces hospitals to charge exorbitant prices. Private insurance options pay larger percentages: 12 - 50%. People without insurance usually will pay either 100% or 0%, with some people negotiating in between.

Honestly, the easiest way to fix it is to get rid of Medicare, Medicaid, and social security or force everyone to pay 100% as opposed to negotiating lower rates.

Fyi I worked in a medical billing office for 5 years. We did payment processing for about 30% of all hospitals on the east coast and Midwest

It's hard to tell if there are inefficiencies and waste or if health care is just simply really expensive.

Health care is done by the Provinces in Canada, with transfers from the Federal Government to help out. The most recent Alberta budget[0] puts the cost of health care at about $20B. This represents approximately 40% of Alberta government spending.

Is that due to waste or inefficiencies? I honestly have no idea. I just know that it's a big number.

Another thing to keep in mind is that, at least in Canada, the government provides some base amount of health services, but there are still other things that aren't covered. In Alberta, someone might go to the ER for a severe asthma attack and that's covered, but the prescriptions to keep the asthma under control are paid for out of pocket or from a benefit plan (which could be an individual plan or through an employer). Similarly, dental is not covered, but may be covered under a benefit plan.

[0] http://finance.alberta.ca/publications/budget/budget2016/fis...

There's no benefit I can see. Our present system combines everything that is bad about "socialized" medicine (loads of regulation, bureaucracy, inflexibility, etc.) with everything that is bad about private medicine (inequality, high cost, fragmentation).

The purpose of government is not to require the most efficient option. Government isn't capable of it anyway. Government is force - nothing more. The purpose of government is to protect our rights. "Single payer" (a euphemism for socialized medicine) by definition violates rights by forcing people to do things against their will. For example, in Canada (until recently) people were prohibited from using private health care even if they want to.

The health systems in Europe are not radically different from the US system. The efficiencies of each are difficult to quantify without context. For example, the US invents most of the drugs and medical technology used by the world. Would this still happen if there was more invasive regulation? We can't know.

Besides all of this, think of every other area of the market where the government insinuates itself. Are public schools better than private schools? Almost never. Is the US postal system better than FedEx? Of course not. The government is not a commercial entity. The incentives and influences on it are not conducive to producing quality products at good prices.

> (government, aka "public option")

that wouldn't happen. since it's monopolism. You would end up in a system like germany. And at the moment these "public" health insurance companies raising their fee's every year. Not better than having private ones, since their regulators just don't care. They praise their reduces with taxes but they don't care if everything else got higher we still end up in a loss.

Personally, I would have split the difference... I would have created an NPO insurance corporation that was the default for all government paid access programs (employees, retired va, medicare/aid, state programs backed by federal funding)... this likely would have cost less than was already being paid out, in effect consolidating the management of several government programs as well as opening that corporation up to the states, businesses and individuals.

Following would have been mandated coverage by employers, and from there would probably have been room to cover most of the rest or provide tax incentives to do so.

As it is, when people are paying the entire premium cost directly, they're far more likely to use that resource more, effectively raising costs... the lockin is another negative issue.

Creating a publicly sponsored baseline would establish more competition and as an NPO incentive to drive down pricing. The larger issue is IP surrounding medications and medical equipment. Much of which could be improved by front-loading patent application fees, reducing the approval rates for extension patents, and statutory licensing fees for medications more than 5 years old.

In the end government should encourage competition, with innovation as a side effect instead of trying to encourage innovation by expanding upon misguided protectionist extremism.

But that's my thought on a pragmatic solution that could have worked better with a libertarian mindset.

In theory? As I understand it ...

A market allows for innovators to find ways to deliver better service for less money and thus offer a more competitive product and gain market share. This competition forces all players to improve, or be forced from the market.

A publicly owned and operated business has no incentive to improve its operational efficiency and little to no incentive to respond to complaints in service.

In the US we have two examples of public insurance providers Medicare and the Veterans Administration (VA).

What we haven't tried as far as I can tell is to apply regulatory pressure with marketing forces. So for example if we made it illegal for pharmaceutical companies from preventing generics to be sold or marketed. If we required by regulation that all facilities publish their costs, and to whom those costs were paid, for every procedure. If we required that all medical procedure costs and options at every facility had to be made available at a publicly searchable database. Etc. It might help in making the market more efficient.

> rather than a single provider of health insurance (government, aka "public option")

Those aren't the same thing at all.

It's impossible to debate health care at all because everyone believes a bunch of fairy tales. HN is an extremely poor place to discuss this, because people here are smart enough to think that they aren't being influenced by politics.

A couple of arguments in favor of a marketplace:

1. In theory, a competitive marketplace should be able to cut costs and improve outcomes by incentivizing innovation and efficiency (of course, you also have to try to guard against incentivizing insurers to cut costs by reducing access to care). 2. Switching to a single-payer model would be incredibly disruptive to the economy. It would need to be done gradually to minimize the pain.

I actually work for a health insurer, but I've also been a big proponent of healthcare reform for quite some time (I see the ACA as a step in the right direction). I'm definitely not opposed to single-payer, but I don't think it would be a silver bullet, either.

The only place I know that actually has a market is Switzerland. Insurers are required to offer "basic insurance." Everyone in the country is required to buy it. If you are below poverty line, it is paid for by the government. What is covered by basic insurance is set by the government, and so independent of insurer. Likewise, what insurers can ask to set rates is set by the government (age, income, sex, and smoking status basically). Insurers are required to sell basic insurance to anyone who wants to purchase. All insurance billing uses the same set of forms, so there's very little office overhead. This actually produces something that looks like a market. You can get on a website, put in a couple of values, and get a lot of quotes instantly, pick one, put in your credit card, and you're insured. Companies also sell further insurance beyond basic, and compete on quality of service for basic.

Swiss healthcare is regarded as decent but far too expensive for what it is compared to the single payer systems in all its neighbors.

Paying for healthcare isn't the place you worry about inefficiencies and waste. It's going to get paid for, and the possible efficiencies of pushing paper around are dwarfed by the cost of actually delivering medical care. So what you actually care about is delivery of health care. Italy does this really well. They have public hospitals and clinics and private ones, too. If you go to a public one, you're covered. If you go to a private one, the government pays the same to the clinic that it would pay to the public clinic. So the public system serves as a reference that the private system has to match in efficiency, performance, and price.

There is no medical or macroeconomic justification for private insurance companies. It's historical accident perpetuated by monied interests.

The benefit vs how they happened are very different things.

Initially, the benefit was that people paid all medical expenses out of pocket and could purchase insurance in case of extreme medical issues.

Businesses started offering health insurance as a perk to attract employees and would negotiate a group rate. This benefits the business by both helping to attract / retain employees as well as helping to keep those employees healthy.

Labor unions campaigned to have employer sponsored health insurance which lead to insurance lock-in to a business, usually on 3-5 year agreements, without the employee having any say in where they were getting their insurance from or how much it cost. In effect, this removed health insurance from the consumer market. Compounding the problem, businesses could tax deduct the cost of insurance while employees could not.

So both the cost and quality of insurance was removed from the consumer market. Insurance removes the cost of medical care from the consumer market. Federal tax deductions only for businesses incentivize this arrangement.

The problem here is not caused by capitalism.

This is also before we take into account sheer supply/demand factors around doctors and the regulatory bodies involved in the supply side.

From the point of view of people opposed to single-payer, you're not even asking the right question. It's not about which is more beneficial on the balance. It's about whether the private sector solution is so broken as to overcome the presumption against a government-run solution.

There's pretty enlightening chart on this article: http://www.commonwealthfund.org/publications/issue-briefs/20...

The general consensus is that the U.S. spends more on health care than other high-income countries but has worse outcomes.

"Data from the OECD show that the U.S. spent 17.1 percent of its gross domestic product (GDP) on health care in 2013. This was almost 50 percent more than the next-highest spender (France, 11.6% of GDP) and almost double what was spent in the U.K. (8.8%)."

If there are benefits to a private system, we aren't seeing them. (That may be because we don't have a private system OR a public system. We have a frankenstein hybrid that's the worst of both and works for no one.)

The biggest problem is all the attention has been focused on who pays, rather than how much. The cost system for US Healthcare is so opaque, so disjointed that no one--not the providers, not the customers, not the insurers--have the required understanding or motivations to control costs.

The best is probably a mix, like Singapore. The citizens win in the case the government provider is efficient or inefficient, because in either scenario the government sets a floor of efficiency that private companies can't go under and survive. In a purely private market there's the potential for collusion, or in a heavily regulated market there's the potential for forced inefficiencies. When you just have the single government provider, you cut off the possibility of doing much better, and you create a big incentive for everyone in the industry to inflate their costs because the government always pays.

Benefit: It got the republican votes necessary to pass the law.

Benefit: It prevented a mass disruption of jobs. Health insurers have lots and lots of workers.

I'm surprised at how many people think the answer is "no benefit" or political expediency.

The hope is that insurers will compete with each other and find ways to reduce costs. Obamacare has regulations designed to prevent the most egregious cost-saving measures (denying claims, rescission, etc), so insurers will have to find ways to reduce costs other than simply not paying. Because many insurers are small, they can try experiments that would be prohibitive in a larger insurer. We'll get a lot of data about what works and what doesn't, which will filter up to larger insurers (like Medicare!).

One example of a way that an insurer could save money is pay-for-performance, that pays health care providers based on the health improvements of their patients instead of volume of services. Aetna is trying this.

That's the case for a market. (There's definitely a case against it too.)

One thing missing from this discussion is the fact that the health care exchanges are small relative to the rest of the market: around 10 million enrollees on the exchanges, compared to ~150 million in employer sponsored plans. This is because Medicaid expansion covered more people, and fewer employers dropped their employee-sponsored health insurance, compared to predictions. So the exchanges aren't really a big player.

Everything the government provides causes lots of inefficiencies and waste, and unintended consequences to boot.

That said, some things may be worth the sacrifice, healthcare may be one of those things. One question to ask, will the quality of care improve (whatever the cost) if the government takes over?

Since the US is made up of states, what is stopping one state from providing single-payer and proving the model works?

Remember that the existence of private players doesn't mean that you have a free market, which tends to drive efficiencies.

In the US, it's more of a planned/command economy.

A retail consumer gets the worst price. (Think the "rack rate that you never pay that's in the back of a hotel door) The government through Medicare/Medicaid/Tricare gets the best price. Everyone else is in the middle, on a spectrum of discount based mostly on size or some other market power.

In a single payer system, you end up controlling costs by compelling the providers to work for the system (similar to an HMO like Kaiser), prioritizing certain services and using regulation to discourage bad vendor behavior, like drug profiteering.

First of all, it makes no sense if you've mandated the specifications of the product being sold via legislation. Having said that, a huge benefit would be the ability to buy insurance: actual insurance, in which you're paying a subscription fee for the service of protecting you from the risk of a huge surgery bill, rather than a payment plan that covers everything inside the walls of a hospital. As a young adult, I would be happy to pay for a service that would insulate me from risk I can't handle, because it would make me financially stable. But if the plan also covers predictable things like obese people needing diabetes meds, children being delivered, and obscenely expensive cancer treatment that only slightly extends a low-quality end of life, that's a different question. Suddenly (probability of medical emergency) X (expected cost) << (cost of insurance premium), even if you add a $500 penalty to the left side of the equation. Bankruptcy seems like the smart insurance if I'm not amassing significant savings, in that case.

Everything outside of those complicated, expensive procedures would suddenly be susceptible to price sensitivity, since the users would also be the people paying. Faced with that pressure, routine procedures would fall to prices that don't look like typos.

Having said that, what I've read about the British system seems like it could be effective, if it were politically feasible: procedures have to stay below the cost per unit of increase in life expectancy or quality of life, or else you have to fund it yourself. When the current American system was being battled into law, it seems like that number was about 30kpounds per year of life.

If the government is going to be making all the decisions there's no benefit. But I doubt we would have had Obamacare at all if he'd proposed a single-payer plan. Insurance companies, which have a lot of clout in Washington, helped push it through because they expected to make more money.

Which, quite frankly, was stupid. It was pretty clear from the outset the ACA would break the US health care system so badly single-payer is the only option going forward.

> Can anyone succinctly explain the benefits of having a market for private health insurance companies, rather than a single provider of health insurance (government, aka "public option")?

Government provision of health insurance means that every procedure covered is a political issue (e.g. abortion for the left, sexual-orientation counselling for the right). This means that there will be nationwide winners and losers, and no-one but the rich will be able to simply change providers, as with a private market. As an example, look at how public schools are run: only the rich are able to opt out of government schooling.

American governments are not capable of running efficient programmes, because to a first approximation American government employment is a make-work program for people who can't get hired at anywhere that cares about competence. That means that a government insurance provider will be incompetent and inefficient.

To make things worse, the employees of said provider will be unionised, and that union will do its best to make it even more inefficient (e.g. take a look at the prison guards' unions).

Switzerland, Germany and other countries lack single player plans. Israel has 4 different integrated health providers that compete to provide care. I am sure there are many other examples of health care systems that choose not to use a single payer.

I'm not well enough informed to give a complete opinion on what's better, because it's a complicated solution. I do know some reasons why a public option might not be good. (This doesn't mean it's the wrong option - just considerations)

1 - When you eliminate competition, you lose innovation and smart cost control. Look at most monopolies for evidence of this.

2 - You wind up forcing a "one size fits all" on everyone. What if some people prefer a bare bones service, and others prefer an advanced one?

3 - How many things does the government really run well?

There's a book called "Catastrophic Care" that directly addresses this question. It's an expansion of an article the same author wrote for The Atlantic (http://www.theatlantic.com/magazine/archive/2009/09/how-amer...). And for a summary of the book in video form, here's a long interview the author did with Malcolm Gladwell: https://www.youtube.com/watch?v=eP--XMgEv4c

To answer your question, the way we think of health insurance isn't compatible with a free market system. Insurance pools risk and money to cap your losses in rare, ruinous events. But that's not how we use health insurance. We use health insurance to pay for low-cost, common, certain-to-happen events (blood work, checkups, X-rays, sprained joints, etc.). To borrow an example from the book, imagine we had grocery insurance. Every month, you paid $500 to the grocery insurance company, and you could go to the store to pick out any covered groceries. The market for food would quickly take on all the negative features we find in the market for healthcare. Prices that are crazy and only get higher, minimal competitive forces against low-quality providers, no transparency for consumers, etc.

Market forces are great at lowering prices while increasing quality, but they only work if people personally decide how and where to spend their money. If you give your money to a third party who then makes all the spending decisions, it smothers all the price/demand/competition signals that providers should naturally get. (And which, in a healthy market, automatically put providers out of business when their prices get to high or their results dip too low.)

To borrow from the book again: it seems crazy to expect people to pay for healthcare out of pocket. But add up your premiums. You're probably paying $6-10k per year right now. That's many times more than enough to cover typical healthcare in most years. With plenty left over to buy catastrophic coverage for high-cost low-probability stuff. And in a market where people are making their own decisions with their own money, prices would quickly drop, which would stretch your out-of-pocket dollars much further than they go today. Every $2500 MRI would go out of business, replaced by $500 ones. (We already see this kind of price deflation in the corners of medicine where people do pay out of pocket, namely laser vision correction, plastic surgery, and to some extent walk-in checkup clinics.)

> Can a capitalist case be made for their existence?

Yes, and rather than do it myself, I'll let Nobel Prize winning economist Milton Friedman do it:

http://www.hoover.org/research/how-cure-health-care-0

Note the date. He did studies in the 1970s and updated them in the 1990s with consistent results. This was all well known and the case was made repeatedly before Obamacare was passed.

Competition is very important. Government provides free education. Is there a case for private educational institutes ? Surely yes there is. Catholic schools, schools focused on gifted children, schools focused on differently-able children etc. that diversity is important in all spheres of life.

Also, please note that when you use words like "government provided insurance" the word insurance can mean something totally different under government just the way we have learned that government's definitions of "traitor", "whistleblower", "sex offender" are different from what common sense might tell us.

If only government provides insurance government also ends up deciding what health services we can use or not use. For example Liberals might say "sex change surgery" is essential procedure and force tax-payers pay for it. Conservatives on other hand might say any health issues occurring because of anal sex will not be covered.

I think one big problem is that American's who support single payer system fail to see that "healthcare" is a lose term and under the "single payer" that definition might change to suite the payer instead of consumers.

I really like this news item : https://www.youtube.com/watch?v=K0e3-EvpDwM

Independent of the presence or absence of a public option, the benefits of a private market largely depend on whether an actual competetive market with consumer choice and pricing comparison can exist. In the US it cannot due to regulatory capture and occupational licensing plaguing the industry and creating massive market distortions. Consumers are completely disconnected from pricing.

Single payer and private markets can be complimentary, with private insurance funding more personalized care and a recourse from the dreaded death panels.

Single payer with private markets seems to be the model many countries are converging on.

I was under the impression that the purpose of the private healthcare marketplace was to satisfy the right-leaning Democrats who were on the fence about passing Obamacare and as a pacifier against a full-scale filibuster by Republicans. I think the architects have known it's going to fail, and want to use this failure as leverage for the creation of the public option.

Anecdotally, while Britain's medical system has less wait times, doctors working for the NHS are chronically overworked and underpaid. Many move to Australia or go into private practice after completing their residencies.

I fail to see how I as a consumer am personally benefitting. I have more expensive healthcare that covers less and it gets more expensive and covers less every year.

I'm sure there are a few very sick people out there who are benefitting. I'm glad that we as a society are able to help them out. But it's clear that I do not have choice in needing healthcare, whereas these providers do have a choice in providing healthcare.

I agree with you that the hybrid approach is not working.

> Individuals who are young and healthy will opt for a lower cost plan,

This doesn't jive with the Obamacare marketing: They specificially needed to get a lot of young healthy people to sign up, because their fees would pay for the older generations who have higher health care costs.

If you think a ~$100,000 a year to a politician (plus another couple million to some other politicians) is largely responsible for the rules that govern how 20% of our economy functions you are quite mistaken.

There are huge economic and political forces at work that render Aetna's tiny expenditure irrelevant in the grand scheme of things.

This is not proof at all that "Obamacare is a Rube Goldberg machine." This is a major insurer pulling out the markets, but over trivial amounts of losses.

I don't know what you mean about Kentucky. There are plenty of health insurance companies with offering on the Kentucky exchanges (Anthem BCBS, CareSource Kentucky, Humana, Aetna, and Bluegrass Family Health). And in any event, even if there truly were no insurance companies with offerings on the Kentucky exchanges, I find it very implausible that either Mitch McConnell, or Rand Paul would have claimed to be "gobsmacked." They were leaders in the fight against ACA, and they certainly claimed before passage that the law would destroy the health care industry.

I'd say a public option would be the way to "soft introduce" single payer. Just expand Medicare to anyone who wants it on the exchanges. Once the premiums shake out, "big bloated government" likely will be pretty competitive.

Of course that would require a major shift in the House of Representatives, which probably won't happen until the 2022 election, after electoral maps are redistricted in 2020 post-census, and the rampant gerrymandering might be fixed. And some kind of political cover from the caterwauls sure to emanate from the health insurance industry.

What corporate chicanery? They took a loss on exchange plans last year. They have every right to pull out of the exchanges until the government makes them stay.

I'm a supporter of single payer. But the health care market is a sterling example of the "worst of all solutions" espoused by the Democrats. Instead of simply raising everyone's taxes to pay for public services, they try to get companies to do hidden cross-subsidization, propping up money-losing individual plans with profits from group plans. And then they berate companies for pulling out of money-losing enterprises, as if providing healthcare for people who can't afford it is the job of private companies rather than the government.

Without a law requiring insurance companies to participate, why should they? Let's not pretend they have anything other than self-interest at stake.

Why not pass such a law? Because that would effectively mean semi-nationalizing a fairly large industry, and if we're going to do that, why not just create an actual single payer and a risk pool the size of the US population and skip the idea of having private firms involved at all.

The biggest problem with the idea of single payer "insurance" is that it's not actually insurance. It bundles in a variety of things such as pre-payment for services, wealth redistribution, price controls for services, and some actual insurance.

A social safety net is a good thing. But if we expect to benefit from the benefits of a competitive system, we have to let firms actually compete.

The core issues have to do with the lack of "insurance" market for things that are actually prepayment (like giving birth, dying of old age after $50K worth of end of life care, etc).

By mandating that consumers buy the "insurance" and mandating that insurers bundle all the non-insurance services into the package, the government essentially controls the market and avoids both the benefits of market competition and accountability for tough decisions such as which care should be covered, etc.

There have been many threats from industry and government. Government can nationalize and can pass laws that reduce profits, and firms can pull back, can merge with each other, and do other things to increase their market power.

The bottom line is that the entire system is ripe for corruption and lack of accountability. Let's face it, for a healthy young person, catastrophic insurance is next to free. Yet all of us are paying fairly high premiums so that old people can be exploited by a healthcare system that happily gives them ineffective surgeries and sells them overpriced and largely ineffective pharmaceuticals.

The system was already corrupt before Obamacare, Obamacare simply cemented many of the most lucrative public/private deals. Both sides intended to scheme a bit after the programs got underway. So we'll see a bit of tit for tat with regulators and perhaps watch one or two of the entrants leave the market allowing the profits to be divided fewer ways.

The "leaked" numbers have always been higher than what actually happens.

The insurance companies always propose higher increases in order to have a stronger bargaining position, and those numbers have historically been bargained down to something decent.

Only 5-10% pay the majority of taxes, but almost everyone is, eventually, not healthy.

Another way to put it is that average lifetime healthcare cost is about $250k for men, $350k for women.

So yes, definitely people should be paying for health insurance while they are healthy, so that they can also have it when they are sick.

In a sense, health insurance should be priced just like a $250k/$350k term-life policy that you take out at birth.

It does have the distinct smell of the broadband subsidies: "Give us money if you want us to roll out high-speed broadband."

"Thanks for the check. Oh, BTW, we decided high-speed broadband wasn't really working for us, so we nixed it."

Aetna deal goes through: "Shockingly, we're still losing money on exchanges, so we're not going to do that anymore. Thanks for letting that merger go through, though."

Anecdotally, any course of action depending on "synergies" being realized will not happen.

How about pharmaceutical companies?

It seems to me that 'insurance' has become more like a group pre-paid debit card for predictable medical expenses than a lower cost hedge against statistically rare events.

That's silly. Insurance is a great method of hedging risk. If my apartment burns down it would cost me A LOT of money to replace my stuff. But the chances of it burning down are really small. So I can purchase renters insurance for just a couple hundred bucks a year, an expense I can easily afford.

That benefits me a great deal!

Maybe when you said insurance you meant to say "health insurance" but the same principle applies. If I have a heart attack then treating it will be hideously expensive, but that's also unlikely to happen.

i couldn't in any good conscience support single-payer or socialized medicine it's the same economic model that created breadlines

Anyone who thinks this is leading to single-payer is dreaming. Whether you think it's a good idea or not, the political will wasn't there for in 6 years ago, and there is much less political will for it now.

I never understood this mindset. It assumes that the govn't is incompetent (which it often is in many areas, fair point), but then ignores the most obvious response, which is to diagnose and fix the problems at hand. Simply abandoning the government solution is not the only option. In fact, one of the government's biggest problems is that so many people are obsessed with neglecting/sabotaging it just to prove some point that it's bad.

Government isn't a company, isn't competing with them, and shouldn't be measured in the way companies are measured; that you're even making this comparison speaks to the fact that you don't understand the purpose of government.

Why do I want centrally planning in my healthcare, because it can accomplish something companies can't: full coverage for all citizens rich and poor alike. No market solution can or will ever provide that, government CAN.