The buying across state lines fallacy

Here's the reality. If you open up all these markets - great. But the result would be quite obvious. First a HUGE government oversight bureacracy would be created (currently insurance policies reflect state oversight). Next, the healthy rush into cheap and partial-coverage policies - creating a rush to the bottom. Picture Walmart moving in and selling crap at bargain prices - now imagine that Walmart going online.

The reality is our market is dominated by a handful of HUGE insurance companies. They leverage their size with hospitals and hospital groups to negotiate the best price for their customers. Imagine spreading out this leverage and creating negotiation rooms piting David v Goliath. So, no - you or I won't be calling Redneck Insurance Co in Amarillo. We'll be calling Healthnet or another massive anti-trust protected insurance company just like we have here in California. Only this time their fees will be solely (and indirectly) controlled by federal government oversight - and not the current state system.

So maybe we see a slight migration of healthy folks as insurance companies cherry-pick the "best ones." But will any insurance company pick up someone with a pre existing condition (particularly if they aren't required to do so)? Of course not - unless they are shitty business people.

So that brings up mandating coverage. The healthy will always subsize the sick, and why a mandate is necessary (plus why would anyone favor a system of free loaders who pile into the ER when they get a sore throat?) Last I checked republicans were for personal responsibility.

Libertarians and election year republicans claim a mandate violates the commerce clause of the constitution. Until someone provides proof that the uninsurance will never need uncompensated care, there is no argument. And that's before we get into the federal powers to tax for insurance (see your w2 FICA withholding).

To be honest - this "state line" talking point is really just that. It solves nothing. It might - MIGHT - mean cheaper and more accessible coverage for the 20-29 non-contra-indicated population. But it would do nothing to decrease costs (again you would be effectively spreading leverage against hospitals/hospital groups) and it puts the feds in a direct oversight position of every insurance company in this country.

So higher costs, more government intervention, a race to the bottom, maybe a few more 20-somethings get coverage, and those with medical conditions are still screwed.

It's a dead end argument from the right.