jsg, Slash,
The choice thing is tossed around like it is a religious mantra. When I am sick I really don’t care about the philosophical benefits of ‘choice’. The term ‘bad’ choice, in this context, is offensive. That’s like the three doors in the Roman Coliseum. The guy who got the tiger made a ‘bad’ choice.
OK, so the economic rationale is beginning to make sense:
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Part D is force fits a capitalist solution to a social need.
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Part D does give initial relief to some low income people who have disastrous illness.
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Insurance companies are profit centers that redistribute revenue and cost. Product pricing is centrally controlled by the profit centers. Internal to the insurance companies the system is socialist.
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The system provides a façade of competition. Preferred supplier networks are barriers to competition. That is their sole purpose and there is no benefit to the ‘client’. Competition is only within negotiation between insurance companies and pharmaceutical manufacturers. There are few client driven market pressures.
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Outside of the donut hole all costs are used to calculate the threshold. Inside the donut hole only client contribution is used to get out.
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Rebates and discounts given to the insurance company increase it’s profit margin and are of no benefit to the ‘client’.
Crane