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About PeterMP

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  • Birthday 07/11/1972

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  1. Whether it is more charitable or not, it is still wrong. Wrong is wrong. But even what you've said here is still wrong because you haven't addressed how long it takes for changes of "this difference in HHI" to happen. You've just assumed that it takes decades for "this difference in HHI" to accumulate or at least the years of the study. Going back to example of the basketball player, if I used data from 5 years and you assumed it took 5 years (or decades) for people to make the change in their mechanics I was studying, you'd likely be wrong. I studied people that changed over that 5 years, but that doesn't mean it takes 5 years to make the change. I don't think you have any idea how much price increase you get in a single year regardless of competition level, especially if you leave out pharmaceutical drugs (which I've already address in the above posts). I don't think you've looked at a study that looks at how much prices increase that takes into account changes in competition level to generate a price increase per a year independent of changes in competition level. And even more than that, I think you don't even understand that you don't know that (and MAYBE you'll know it now that I've pointed it out to you, but I'm not super optimistic on that front). I don't think there's a study out there where if you take out drugs, you could use their results to make a graph of price increase (or inflation or whatever) accounting independent of changes in competition vs. years (I've really got be done with this. I'm sorry. It bugs me to leave something that's just wrong posted, but I'm too busy this week to keep correcting your errors so I'm going to have let them go if you post more. But I'll give you another piece of advice. Health economists are generally smart people and generally you don't get into health economics to do abstract work, and you certainly don't advance in it doing abstract work. And based on the number of links I've given you, it is clear there's a lot of studying going in the area of consolidation. They aren't generally wasting their time studying things that are practically irrelevant. The lead author on this study is the chair of the Department of Health Research and Policy. You don't get to be the chair of the Department of Health Research and Policy and have your research published in JAMA if people don't think it has practical significance. If you don't understand work, some times it is useful to consider how much work is being done in the general area, who published the work, and where it was published to understand its at least perceived importance. Work of perceived less significance isn't likely to make it to a front line journal and be coupled with a press release from Stanford.) **EDIT** This might help you understand the point I'm making about what I don't think you understand. He's plotting temperature anomaly vs. year, but it isn't the true measured temperature anomaly. He's used statistical methods based on observed results to try to remove natural affects (volcanos, El Nino, etc.) that affect temperature. I don't think you have any idea what the comparable graph of health care costs-drugs would look like if the effects of changes in competition were removed as he's (at least attempted) to remove the effects of natural events from his graph. You only know what graphs look like with the measured values, but competition is changing with years too, and you don't know what that graph would look like if you took out the effects of competition.
  2. You really are great. It isn't 3-5% over the years. It is 3-5% from higher competition areas and lower competition areas. HHI is a measure of competition. If you live in an area with a high HHI that indicates a lack of competition. "In our more conservative model, this difference in the HHI was associated with 3.5% to 5.4% higher mean prices." In the years they studied, if you lived in area with high competition changes that resulted in lower competition (to a certain level of low) would reasonably increased prices for doctor visits by 3.5 to 5.4%. In 2010 if you lived in a high competition environment and something happened and your area become a lower competition environment you could have reasonably expect prices for a doctors visit to go up 3.5 to 5.4%. And unless you believe that something has changed compared to the years they studied, then the same is true today. If the level of competition where you live drops by "this difference in HHI", you could reasonably expect prices for doctors to go up 3.5-5.4% It is like saying, I studied basketball players shot mechanics over a period of years and people that made this change to shooting their mechanics saw their shooting percentage will go up by X%. None of the numbers you have talked about are given as X% over this period of years. (Just a piece of advice, you essentially never see anybody that does a study over a period of years that ends with results over the period of years they are studying because if you do that it makes it is difficult for you to compare your results to anybody else's and anybody else to compare their results to yours. If I do a study based on data from 2010-2013 and that's the most basic result I give, unless somebody else does a study from 2010-2013, my results are at best hard to be compared to theirs. Anybody that knows what they are doing is going to try to give put their results in some sort of more generalized format. It is hard to write a conclusion that's going to get published if you can't compare to other studies, and it is certainly going to negatively affect how much you get cited.)
  3. I'm sorry, but I can't pass this one up. "If correlation between higher cost and consolidation is caused by something other than elasticity, then the factors that drove the higher cost will still be there after rolling back consolidation." "Assumption that market forces will lower healthcare costs also assumes that consumers will put cost at a very high consideration. If that were true, people would switch to HMOs." Study from 1998: "Antitrust advocates believe that horizontal consolidation in hospital markets can reduce competition and increase prices while merger advocates believe it can benefit consumers by reducing service duplication. " "Merger advocates say that applying traditional antitrust concepts to the health care sector prevents economies of scale from being realized and increases prices." The study actually concludes that consolidation does lower prices, which with some other studies drives thinking in the 2000s that consolidation is actually good. And so you get things like: "Carilion says it represents an ideal envisioned by the nation's new health-care law: a network that increases efficiency by bringing more doctors and hospitals onto one team, integrating care from the doctor's office to the operating room. The name for such networks, which the new law strongly promotes with pilot programs, is accountable care organizations, or ACOs -- providers joining together to be "accountable" for the total care of patients, with incentives from insurers to keep people healthy and costs down." I added the underline and italics for you. "Health care industry pundits believe the Patient Protection and Affordable Care Act (PPACA) of 2010 will restructure the way millions of Americans receive health insurance, but that it may do little to control costs. There is concern that one of the unintended consequences will be further consolidation of hospitals and physicians, which could result in still higher prices. Largely overlooked by many critics, however, are payment and delivery system reforms in the legislation that will lead to the further development of accountable care organizations (ACOs). If the payment reforms are fully implemented, ACOs have the capacity to significantly reduce costs and restructure health care delivery." "Job #1 of ACOs is to reduce costs." People not only argued that consolidation wouldn't necessarily raise prices (i.e. the use of could above). They actually argued the consolidation would lower prices. There was a belief that the health care market was inelastic enough that consolidation could happen and not just not increase prices, but still see prices go down because of economies of scale. That the advantage of economies of scale would off set any elasticity in the health care market. It isn't a straw man. So market forces can lower costs without people switching to HMOs (outside of special cases like high tech MRIs)? Is it an assumption or something nobody really disputes? It is 3.2% increase of hospital costs PER a standard deviation in market share of fully integrated organizations. Not 3.2% increase over the whole time period. Market share of fully integrated organizations increase a little less than 15% during that time period. The standard deviation is 0.325 so it is like 46 standard deviation units. Now, the math gets hard from there to turn it into a percent of health care spending because you'd have to know what percent of hospital costs is healthcare spending and how much of that spending is associated with fully integrated organizations (which I guess would be related to their market share). You've sort of done an apples to oranges comparison in your post that I'm not comfortable with at all. Then 3.2% of HMO premiums IN 2001 (in ONE year), which is a completely different than the 3.2% PER A STANDARD DEVIATION UNIT for hospitals. Then there's physician costs, tests costs, etc. All of those percents add up. (And that doesn't even touch prescription drug prices, which have been a major driver of health care costs over the relevant period of time.) If you have a little bit of experience with multivariate statistics, then it is pretty clear this is a pretty large affect for the things they are looking at (e.g. hospital costs). People don't keep finding significant results if the thing isn't very important in different studies. Things that are close the noise level frequently show up as noise. Total health care costs increases for years were driven heavily by drug prices so in that context, they might not be overly large. But that's why you need another approach to deal with drug prices. (I will apologize. I butchered the part about what you said and then didn't clarify very well. This statement isn't true: "If correlation between higher cost and consolidation is caused by something other than elasticity, then the factors that drove the higher cost will still be there after rolling back consolidation." It is very possible that even if the relationship between higher costs and consolidation are due to something other than elasticity that prices will still come down (which is the point I think I made sufficiently clearly in the part you edited it out in your other reply). I think the idea that the link between consolidation, competition and prices isn't due to elasticity doesn't hold much water, but there are number of mechanisms by which it could not be and you'd still see prices come down by rolling back consolidation. )
  4. For most of the last 2 days, we've talking about prices in the context of health care costs. I just brought premiums in the context of the last post to show the extent of the work that has been done related to consolidation and the extent of the effect it has been found to have on the health care system. I was just trying to eliminate this idea that consolidation having an effect is based on correlations and in not many studies or somehow was not very believable, which it seemed to me was being implied. Generally, I think many moderates (including the likes of Biden for the Democrats) have moved on to healthcare costs. There is a sense that with the ACA we have the insurance side under some control (the overhead issue is an issue), and the next step is to tackle the underlying healthcare costs. Biden's plan is about lowering prescription drugs costs, hospital costs, etc, while getting more people insured and increasing competition in the insurance market too.
  5. 1. It was strongly implied. You added the comparison to other industries, which was not implied. Heavily requires a comparison to something (heavily with respect to what?). You added the comparison to other industries, which was not implied. The post also talks about liberal economists. Clearly, the ACA was not passed with the idea that consolidation would appear to increase prices and lower quality. If you told the people that designed and wrote the ACA that in 2019 that a large number of studies showed that consolidation in the health care industry increased prices and lowered quality the ACA would have been written differently. 2. For the false, I left out the word inelastic. I think I made the point sufficiently well in the part that you edited out. Your statement was false. 3. You gave a study related to the correlation between quality and consolidation. Not costs. And the said study by your own admission was limited in terms of what it looked at (heart attacks, I believe) and in another country. As in with many things, there is no single driving factor, but there is a lot of evidence that consolidation is a significant factor in increasing prices. I've already given multiple studies in the other thread related to different parts of the health care industry as I've also done with respect to quality. But I'll give you more: "We found that an increase in the market share of hospitals with the tightest vertically integrated relationship with physicians—ownership of physician practices—was associated with higher hospital prices and spending. We found that an increase in contractual integration reduced the frequency of hospital admissions, but this effect was relatively small. Taken together, our results provide a mixed, although somewhat negative, picture of vertical integration from the perspective of the privately insured." "We examine the effects of hospital consolidation on the actual prices paid by preferred provider organizations. We find that price increases following consolidations among nearby hospitals invariably equaled or exceeded median price increases among other hospitals in the same market. Using multivariate regression analysis, we find that consolidation enables hospitals to increase prices in three of the four markets studied; these increases are generally statistically significant. In the remaining market, the measured effect was zero. Our results suggest that some, but not all, consolidations of competing hospitals facilitate price increases. We conclude that antitrust scrutiny of hospital consolidation is warranted." (Note, here we're getting beyond what is paid by people and what PPOs are paying.) "As expected, we find that premiums are indeed higher for plans sold in markets with higher levels of concentration relevant to insurer transactions with employers, lower for plans in markets with higher levels of insurer concentration relevant to insurer bargaining with hospitals, and higher for plans in markets with higher levels of hospital market concentration." (and here we get premiums) " In 2001, average HMO premiums are estimated to be 3.2% higher than they would have been absent any hospital merger activity during the 1990s. In 2003, we estimate that because of hospital mergers private insurance rolls declined by approximately .3 percentage points or approximately 695,000 lives with the vast majority of those who lost private insurance joining the ranks of the uninsured. Our estimates imply that hospital mergers resulted in a cumulative consumer surplus loss of over $42.2 billion between 1990 and 2001. It is estimated that all but a modest $95.4 million of the loss in consumer surplus is transferred from consumers to providers." "We measured health plan, hospital, and medical group market concentration using the well-known Herfindahl-Hirschman Index (HHI) and used a multivariate regression model to relate these measures to premium growth. Both states exhibited a positive association between hospital concentration and premium growth and a positive (but not statistically significant) association between medical group concentration and premium growth." There are a large number of studies over years looking at different aspects of the health care industry using statistical approaches beyond basic correlations (i.e. multivariate statistics that are designed to account for confounding and other explanatory factors) that indicate consolidation drives up prices, premium costs, and drive down quality. I know that goes against your pre-conceived notions, but that is what is supported by the data. As for the determined inelasticity in the paper you posted. What you are doing is taking values from a set of people where we expect to see inelastic behavior and saying based on that the whole market is inelastic. And ignoring other studies. The analogy using airlines would be that somebody does a survey of first class fliers that heavily don't care about prices and finds low elasticity. And then ignoring other studies show that airline prices over all respond to changes in competition and declare for all cases air lines show low elasticity. Now, in terms of the healthcare costs with respect to other countries (i.e. Europe), as other countries have different health care systems, there is no single answer. But as I've already noted, much of the difference is due to greater over head costs. I've already addressed that in multiple posts. We can talk about why there's sort of a baseline difference (i.e. heavily because of greater over head costs) with respect to other countries and given those baseline cost differences why costs are still going up faster in the US (i.e. partly due to consolidation). Obviously, there are always unknowns, but we also have reasonably large amount of data available to us on the issue. And based on that data in totality, it strongly appears that consolidation and lack of competition causes significant increases in prices, costs, and premiums through different parts of the health care system. Studies that come to these conclusions do try to control for other factors. It is completely reasonable that reversing consolidation and increasing competition will lower costs, prices, and premiums. Any other conclusion is not well supported by the available data. And with that I'm done here.
  6. No that wasn't my response to your first post. It was PART of my post to your first post that was clearly tagged onto the end as a parenthetical comment with an edit. It clearly wasn't meant to be the most significant part of my first post. My first post also talked about reversing consolidation being something that lowers prices and that the mechanism doesn't really matter, which wasn't part of a parenthetical comment tagged onto the with an edit all of which you managed to drop in your quote. "We can argue over the mechanism of the process, but it is hard to believe if consolidation is driving price increases to patients and competition is tied to lower prices that reversing the consolidations that have happened won't lower prices. Now, it might not be much or enough (and I tend to think it won't and if you go back to one of my posts I alluded to doing what was done to the insurance industry to other industries, and I suspect that we'll probably have to do the same with healthcare providers (e.g. profits and upper level management compensation will have to be capped for large health care providers)). But to unilaterally declare it isn't enough or to hold that it won't work at all isn't supported by the evidence." I was already telling you there, I didn't care about the mechanism and was talking about what would be enough or work and that was the main point. Not the part tagged onto the end as an edit in a parenthetical comment. And the part you quoted is still correct. No, the health care market isn't probably like some other markets, but it appears to be more elastic than expected at the time the ACA was drafted. The part you are quoting doesn't mention other markets. It is talking about a comparison in time. The health care market appears to be heavily elastic as compared to what was expected prior to the drafting of the ACA. And my point is that if there are people out there with good enough insurance that they don't really care about their costs, then that if they don't respond based on prices, I don't care. As I've said, health care is inelastic for me because the costs don't matter much to me because they are low. We don't have to trash our health care system and create a new one for me. Most people with private insurance are happy with their health care. Arguing that we have to completely reinvent a health care system for a group of people that are generally happy with it, especially if that group can be expanded on, doesn't make much sense. We only need to lower costs for the group(s) that actually care about costs (and probably the government) (and therefore respond to prices). This part isn't true. Even given your examples, if some of those things are true, then you'd expect rolling back consolidation to lower prices. If hospitals think the health care industry is more elastic than it is, then rolling back consolidation would reasonably lower prices. If hospitals even perceive they need to lower their prices when in a more competitive environment, then increasing competition will lower prices. If people that run small health care systems are more in touch with their community and just except less profits because of that connection, then rolling back consolidation would reasonably lower prices. It is possible that rolling back consolidation won't lower prices. But to say it won't happen (for sure), is just false. Also studies that look at the effect of consolidation do normally try to correct and control for different obvious variables (e.g. rural vs. urban, etc.). It is a correlation, but it is a correlation where people are trying to control for confounding and other possible explanatory factors. And when they do so, consolidation is still a driving factor with respect to increase costs.
  7. No, the original point is that Biden's plan (which includes reversing consolidation) might bring down medical costs in manner that might be "enough", or even at least be a good first step in a process that is "enough". Consolidation certainly appears to have been a significant driver of cost increases and that a plan that includes reversing consolidation coupled with other ideas might be "enough". Not that healthcare behave identical to other markets. The conversation started in the context of the various health care plans that are being supported by the Presidential candidates. And yes, the data includes people that aren't Walmart executives, but you also have to realize that the data includes people that are insured based on the results are based on their type of insurance and includes Walmart executives and we don't really know what the mix. It isn't hard to understand that people that are insured and are picking their insurance based on their economic situation might be misrepresentative with respect to the larger population that we really need to really help with health care costs. As part of that, emergency room spending is actually something that other studies find changes a lot when people gain insurance. People without insurance don't tend to go ERs, but people with insurance are more likely to go to an ER. And so you actually get larger differences when people go from being insured to being uninsured with ER elasticity. e.g. ER visits increase with Medicaid expansion for non-emergency uses: That for this subset of people that ERs are inelastic isn't that surprising because they have insurance. I'm not going to say for the people that it matters most to that the health care market behaves just like other traditional markets. But it is clear that consolidation is causing prices to increase without any clear benefits. The health care market appears to behave much more like other markets than was expected in 2008. Consolidation appears to have caused prices to go up with AT BEST no affect on quality, which is what you'd expect of traditional markets. Maybe the result(s) aren't the same magnitude as you'd see in other markets, but the general behavior is the same. And a plan that includes reversing consolidation might be a good first step in something that is "enough". (I've already said, I suspect you will have to do more than what is in Biden's plan and cap profits and CEO compensation for large health care companies directly, if legally/Constitutionally possible. And even that won't eliminate the issue of over head costs so in the end a nationalized system might be required. That is heavily going to depend on what your idea of "enough" is.)
  8. And I want to make it clear, I'm not really against a nationalized health care system. There's no doubt that a nationalized health care system lowers over head costs and for an industry like health care that's a significant driver of costs. And given the importance of health care, that might be a reasonable thing to do to bring down costs. (Taking this back to the direction of the election thread then) From my perspective, in the current Democratic party you seem to have an extreme where Biden is still to the right of many other western countries in terms of a health care plan, while the Bernie's plan group are to the left. Nobody really seems to proposing what has worked in many other western countries (e.g. a plan that is literally Medicare of all).
  9. 1. That consolidation (and lack of competition) have a negative impact on quality just comes from one study is just wrong. There are multiple studies that find that consolidation and lack of competition drives down quality in the US in multiple different places over a period of years now. I don't change my mind based on one study, especially a very limited study. E.g. hospitals from 2012 Dialysis facilities in 2018: There are also studies that show that costs differences in PCPs aren't tied to better quality and that PCP prices are tied to competition. At best, consolidation is having a very mixed affect on quality. 2. Walmart isn't providing insurance to many of its employees though so the ones that don't have insurance through Walmart aren't included in the study. Walmart provides no health insurance for part time employees. And yes, the total costs of healthcare in the study is significant and for the things that are more significant you see greater elasticity. But the preventative care costs are low. We aren't talking about overhauling our health care system because of the costs of preventative care in that study. That in a study with low preventative care costs that it is inelastic isn't at all surprising. Everybody I know shops around for airline prices and tickets. Price isn't the only thing that matters (quality in terms of stops, etc.), but prices are a big driving factor. I don't know anybody that just says they always fly whatever airline without looking at prices. (And again, the mechanism at which consolidation affects prices is essentially irrelevant. Whether prices are rising because people can't shop around or some other factor isn't important unless it is something like increased quality. Which certainly doesn't seem to be happening (large scale or across the board).)
  10. 1. You're ignoring data because of a pre-conceived notion. Data should cause to you to re-consider your preconceived notions. That some very good health care systems are large isn't really good evidence that all large health care systems are good. In any other industry, it is largely accepted that a decrease in competition raises prices and lowers quality. That's exactly what we are seeing in the health care industry. 2. The study only looks at people with insurance that work for big companies. Those are the people that we have to worry about the least. Mean monthly spending for preventative care is only $5 for the people in this study. People that spend on average $5 for their preventative care (because insurance is picking up the rest) aren't the issue and yes for them preventative care is going to be mostly inelastic. That's my family and yes, for my wife and I healthcare in general is largely inelastic. We have different PCPs, but it has nothing to do with costs. She goes to a large health care system because she perceives that she's getting better care. I go to a small local doctor because it is more convenient (closer to my home and when I go shorter waiting times). Neither of us considers costs because our costs don't change much based on provider (e.g. my co-pay is what my co-pay is). But we also don't need the health care system to change for us. Same thing for things like pharmacies. My costs are low enough that I don't shop around. We aren't talking about re-shaping our health care system based on people spending $5 a month on preventative care. (Interestingly even for those people, emergency care appears to be more elastic than preventative care, and I've already shown that consolidation increases PCP costs by 5%. It seems possible than that emergency care costs are going up because of consolidation.) **EDIT** I sympathize with you. If you would have told 2010 me that consolidation in the health care industry would drive up prices and drive down quality, I'd have told you were likely wrong. I would have argued (and did argue) that health care is largely inelastic and that competition and (control of) supply didn't matter much. But we now have years of studies saying that's what happened, and it appears to be happening at every level (hospitals, specialists and PCPs) based on different studies. To hold that same view given the current data doesn't make sense.
  11. The link to the Stanford article specifically looks at doctors. And studies over a period of years also show that consolidation seems to drive DOWN quality so the idea that the difference is changes in quality seems unlikely. (That quality goes down with consolidation was also reasonable if the health care market is pretty elastic.) While I don't know a single study that has looked at everything together that prices are going up because quality is going up explanation doesn't jive with the idea that separate studies are showing that consolidation is driving up prices and down qualities. We aren't talking about a few studies over a few years. Studies over 5+ years have pretty consistently shown consolidation drives up prices and down quality. The health care market seems like it was more elastic (more controlled by supply and demand) than people anticipated. (I guess in the specific WV case it is possible, but in general it seems very unlikely.) I think you are also underplaying the role of vertical monopolies and integration. Consolidation happens not just horizontally, but vertically as hospitals get larger, which can affect primary care physicians (PCPs), meaning preventative care. And there are also studies that show more expensive PCPs aren't significantly tied to be better health out comes. So again the idea that higher prices are tied to better quality doesn't seem to jive with combinations of studies. (5% increase in PCP prices tied to consolidation, and I'm pretty sure I've seen studies that put an even larger number on it especially when you take into account tests, labs, etc. (who cares where they get their labs done?)). Emergency care I'm not sure about (to my knowledge no studies have been done), but if competition affects prices at every other level of care, it certainly seems like it could affecting emergency care too. Can there be price pressure even if patients don't/can't shop around (much)? If you know a hospital a few miles away is offering lower emergency medical care prices does that cause your prices to go down?
  12. Taken to the Obamacare thread because we've gotten pretty far off topic from discussing Presidential candidates proposals and discussing health care in more general.
  13. PeterMP

    Prison Reform

    I want to respond with the laugh, but that doesn't seem appropriate. (Good job!)
  14. There are multiple studies that show consolidation is a major driving force of increase patient costs. E.g. and competition keeps prices low: We can argue over the mechanism of the process, but it is hard to believe if consolidation is driving price increases to patients and competition is tied to lower prices that reversing the consolidations that have happened won't lower prices. Now, it might not be much or enough (and I tend to think it won't and if you go back to one of my posts I alluded to doing what was done to the insurance industry to other industries, and I suspect that we'll probably have to do the same with healthcare providers (e.g. profits and upper level management compensation will have to be capped for large health care providers)). But to unilaterally declare it isn't enough or to hold that it won't work at all isn't supported by the evidence. Up to a 54% increase for a hospital isn't something to sneeze at. And as @Renegade7 stated it is a complex problem and attacking it in pieces probably makes sense. If you can get a national public option and caps on drug prices to with stand court challenges and show they work, then doing more with respect to health care providers becomes a lot more feasible (at that time, the providers will become willing negotiators in terms of future and further regulation). (**EDIT** I'm sure if you look, you can find old posts of mine here where I argue that the health care market/industries are heavily inelastic. Which is essentially what you are arguing and has been a pretty common view by liberal economists. But over the last 5+ years there has been a number of studies that show that isn't the case. I'm honestly not sure why the markets appear to be as elastic as they are, but it is hard to argue with the studies that have come out. And I'd still argue the health care market/industries aren't rational or good markets for the reasons laid out by @gbear , but it is pretty clear they are heavily elastic (and going to a nationalized health care system won't make them rational or good markets either, I don't think.).)
  15. 1. As has been stated in this thread by others, the idea that people getting sick (earlier in life) raises costs isn't well supported. And there's little evidence to the value of most organic foods. And reducing CO2 output won't necessarily do anything for other types of pollution. In fact things like solar panels are based on pretty unhealthy molecules so if the green new deal results in more solar panels generated in the US, almost by default you'll have more people exposed to those chemicals and negative health consequences as a result. So you have big trouble if those are important ideas for reducing health care costs. But that's not what I'm talking about anyway. Bernie's plan is likely going to make consumption of unnecessary health care worse and as such drive up costs in a way that it makes it look like we're getting a better value even if we aren't. 2. Biden's plan doesn't really address #1 in terms of drug prices. Most plans don't directly. The only way to address #1 is to have somebody other than somebody's doctor to say which tests and things should be done for somebody. I don't think anybody running for President is doing that (even Sanders). If you increase competition by preventing or eliminating mergers, prices for everything should come down. Consolidation in all industries, including health care, causes prices to raise for pretty much everything. In addition, there is a public option. If you have a baby and have insurance through a public option, then your costs are likely to come down (vs. if you have no insurance). And okay, based on what you do know, how do you know that Biden's efforts to go after #2 and #3 isn't enough? If we can back track some of the consolidation that has happened in the health care industry and have a public option that gives people (more) choices, how do you know that isn't enough to generally lower health care costs? (coupled with increase support of lower class people). What support do you actually have to conclude: "It's not enough, bro, it's too heavily focused on drug prices, every price concerning health care is going up, not jus drug prices." 3. I generally don't care if people don't like my tone, but I do care even less over a computer because tone is pretty much meaningless. It isn't like you can actually hear my tone. Your concept of my tone is generally based on your perception of what I've written and that very much depends on my background in terms of how I write vs. you. And there are too many people with too many different backgrounds for me to worry about how one person perceives my tone in written text vs. making the points I want to make as quickly and directly as possible.