Pansynthesis

"There are two fundamental problems we face with our health care system. The first is the fact that tens of millions of people in this country are either uninsured or under-insured. The second is the fact that health care costs are rising rapidly. [...]

"The one idea that Republicans have offered to address these problems is relatively easy to understand. They want to allow private health insurers to sell policies across state lines. Thus, as long as an insurer complies with the regulations of its home state, it could sell insurance outside of the state. This would increase the amount of competition and thereby reduce premiums. The problem with this idea, of course, is that it would create an instant 'race to the bottom.' The insurance industry would lobby the states to relax their regulations and then would all set up shop in the state that was most willing to comply with their demands. The result would de facto deregulation of the industry. But, from the GOP perspective, this is a feature, not a bug. [...] the result would be a system in which just about everyone is under-insured.

"But this is exactly what conservatives want. They believe (or at least claim to believe) that the reason health care costs are out of control is because people don't have enough personal stake in health care spending. The believe that if people have to pay a greater percentage of costs out-of-pocket, they will have an incentive not to 'purchase' unnecessary care.

"As anyone who has studied health care policy for more than ten seconds knows, however, treating health care like grocery shopping is a recipe for disaster. First, when it comes to health care, 'consumers' simply don't have the expertise to be intelligent 'shoppers.' [...] when you make people pay for routine and preventative medical care out-of-pocket (as high deductible policies do), the inevitable result is that people don't get enough routine and preventative care."