Local follies

I am a retired insurance administrator. I worked for MUTUAL life companies that offered health insurance. As mutual companies profits if any go to policyholders the life insurance side of the business often subsidized the health insurance until losses exceeded the actual premiums then many withdrew from the market.
Deborah in her infinite wisdom failed to understand that premiums cover a period of a year plus up to 12 or 24 months as claims are delayed in many cases. Funds of Mutual Life companies were held in reserve to pay these claims.
After 24 years I established my own claims administration company handling self insured companies. These were immune from Deborah and worked well being properly reinsured and using intelligent claims administration. Benefits were good and costs were less than insured plans.
We can help the problem for small business if the insurance department would allow self insured groups of small employers and set up the proper restricitions on reinsurance and funding.

1) I don't know if there is such a thing as 'an easy Democrat for Republicans to beat' in Washington. Lenin could probably win Seattle, but he might be too far to the right.

2) Set urgent health care aside for a second. For _non_urgent health care there's a couple of asinine things going on. A private citizen walks in off the street at gets an XRay at Swedish -> $300. The _same_ person gets the _same_ XRay taken care of via insurance - the insurance company was billed $38 by the hospital. (This exact thing happened to my daughter, I received the 'no insurance' bill as an error on the hospital's part). That's nuts. Look at the way auto insurance works - you get a quote from an adjustor. It doesn't matter if you get your brother to fix the damage, or some fancy place - the insurance company pays _you_ the money regardless. (Not all insurance works this way, but you get the idea.) With the upfront billing, and the option to _comparison_shop_ and medical savings accounts (Think IRAs) you've introduced some strong market forces into the current mix. Which, in Seattle, isn't dynamic at all - there's Swedish & the 'state' hospitals aka UW/Harborview/VA. The little guys have been wiped out.

My (very amature) theory:
1. Health care inflation causes healthy people to forego insurance. In other words inflation is the real problem and lack of insurance merely one consequence.
2. The fact that we subsidize health care on the consumption side more than the supply side causes health care inflation.
3. This pattern or government intervention causing price increases over time is also observed in higher education but not in agriculture, where subsidies are supply side.
4. Conclusion: switching our subsidies from those consuming health services to those providing them might end health care inflation. Once health care inflation is zero (relative to general wages and prices), providing basic and catastrophic care to everyone will be affordable.