All of the critics are aware of the Sunby story. Here's my focus. (emphasis mine)
You would think it would be simple to find a health-exchange plan that allows me, living in San Diego, to continue to see my primary oncologist at Stanford University and my primary care doctors at the University of California, San Diego. Not so. UCSD has agreed to accept only one Covered California plan—a very restrictive Anthem EPO Plan.EPO stands for exclusive provider organization, which means the plan has a small network of doctors and facilities and no out-of-network coverage (as in a preferred-provider organization plan) except for emergencies. Stanford accepts an Anthem PPO plan but it is not available for purchase in San Diego (only Anthem HMO and EPO plans are available in San Diego).
So if I go with a health-exchange plan, I must choose between Stanford and UCSD. Stanford has kept me alive—but UCSD has provided emergency and local treatment support during wretched periods of this disease, and it is where my primary-care doctors are.
Before the Affordable Care Act, health-insurance policies could not be sold across state lines; now policies sold on the Affordable Care Act exchanges may not be offered across county lines.
Several years ago, my biggest point was that the main problem with the costs of healthcare in America had to do with the fact that many states restrained competition by granting only one or two health insurers to work in a particular city or county. I spoke to my cousin who is a trauma surgeon, and he said it was the reason he left Philadelphia. Oligopoly and monopoly determined what procedures doctors and hospitals could be reimbursed for in their treatments. It wasn't about the best care for the patient given a broad variety of choices, it was about what insurers decided to pay for. So long as insurers could maintain a monopoly, and not be faced with interstate competition, they made out and care providers were hamstrung.
Well I can't find the reference, but that was one of my major ideas. It's in here somewhere.
I also can't find old DMG, our gastroenterologic expert who used to hang out here.