Healthcare consolidation perverted by pricing power

Last week, I noted Eduardo Porter's warning that the ACA was spurring hospital consolidation, which increases the hospitals' pricing power. That's the downside of consolidation. Below, that post is updated with a snapshot of the upside of consolidation, realizable when the power to set prices lies elsewhere.
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Eduardo Porter today spotlights a key factor in healthcare inflation: consolidation among hospitals and other healthcare providers:

What is missing from the stampede of policy innovation is something to tackle one of the best-known causes of high costs in the book: excessive market concentration. 

Two decades ago, there were on average about four rival hospital systems of roughly equal size in each metropolitan area, according to research by Martin S. Gaynor of Carnegie Mellon University and Robert J. Town of the University of Pennsylvania. By 2006, the number of competitors was down to three. 

The share of metropolitan areas with highly concentrated hospital markets, by the standards of antitrust enforcers at the Justice Department and the Federal Trade Commission, rose to 77 percent from 63 percent over the period. 

Did Obama just cross a Rubicreek in Syria?

Just how much of a game changer was the Obama administration's announcement yesterday that it would start providing lethal aid to selected Syrian rebels?  This was one case where the feints and false starts in the news-breaking process suggest that there may have been less of a departure from existing policy than meets the eye. At least, that's what my absorption of the news over an evening and morning suggested to me.

At around 4:45 ET yesterday, a short item in the WSJ Online reported rather ambiguously about a U.S. "proposal" to establish a no-fly zone in a strategic 25-mile sliver of Syria, at the Jordanian border.  The wording immediately raised the question, who was proposing to whom?

1. Daily Intelligencer ‏@intelligencer 19h

   WSJ: U.S. PROPOSES NO-FLY ZONE INSIDE SYRIA http://on.wsj.com/141Fcsv

   
   
2. xpostfactoid ‏@xpostfactoid1 19h

   @intelligencer @lrozen "proposes" to whom? Is this a plan/option or a decided-upon course of action?

   4:47 PM - 13 Jun 13 · Details 

As the WSJ story accrued new paragraphs a few minutes later, it was looking awfully like certain sources were trying to create a reality:

Do past abuses of personal data point toward future abuses of NSA metadata collection?

Stephen Walt spotlights why we worry about metadata collection:

The real risk to our democracy is what this situation does to potential dissenters, whistle-blowers, investigative journalists, and anyone else who thinks that some aspect of government policy might be boneheaded, unethical, or maybe even illegal. If you are one of those people -- even on just a single issue -- and you decide to go public with your concerns, there's a possibility that someone who doesn't like what you are doing will decide to see what they can find out about you. It doesn't have to be the attorney general either; it might just be some anonymous midlevel bureaucrat or overly zealous defense contractor. Or maybe it will be someone who wants to suck up to their superiors by taking down a critic or who wants to have their own 15 minutes of fame. It really doesn't matter: Unless you've lived an absolutely pristine online and cellular life, you might wake up to discover that some regrettable moment from your past is suddenly being plastered all over the blogosphere or discussed in the New York Times. 

 In a way, though, Walt's evidence that we should worry cuts two ways:

Healthcare competition is good. Uniform pricing is better

Eduardo Porter today spotlights a key factor in healthcare inflation: consolidation among hospitals and other healthcare providers:

What is missing from the stampede of policy innovation is something to tackle one of the best-known causes of high costs in the book: excessive market concentration. 

Two decades ago, there were on average about four rival hospital systems of roughly equal size in each metropolitan area, according to research by Martin S. Gaynor of Carnegie Mellon University and Robert J. Town of the University of Pennsylvania. By 2006, the number of competitors was down to three. 

The share of metropolitan areas with highly concentrated hospital markets, by the standards of antitrust enforcers at the Justice Department and the Federal Trade Commission, rose to 77 percent from 63 percent over the period. 

The moral carpet bombing of Edward Snowden has begun

David Brooks vents his prejudices and treats us to pop sociology in search of moral clarity this morning. Nice how some things don't change.

Brooks first reduces Edward Snowden to a social stereotype on flimsy evidence, then condemns him in high moral dudgeon, then undercuts the basis of his condemnation without noticing. For bonus points, he throws in a near-nonsense assertion about the founding fathers' original intent that, insofar as it has any meaning at all, is more false than true.

Brooks' lede intones, "From what we know so far, Edward Snowden appears to be the ultimate unmediated man." That's Brookspeak for 'not a good boy.'  He does not accept the authority and inherent benevolence of Institutions -- in Brooksworld, the repository of all moral value.

Condemning the world's anti-Boy Scouts does not exhaust Brooks' font of indignation. No, the charge must be generational and societal. We are All at Fault, for we are raising a generation of idiots (in the Greek sense of individuals isolated from society):

Intelligence's Heisenberg Principle

Two Times articles about the Edward Snowden leaks suggest variants of a kind of Heisenberg Principle of intelligence gathering. First: the better you share information, the more the information will be "shared" in unintended ways, perhaps affecting your ability to gather it:

Some outside experts said the push in recent years to break down barriers between spy agencies and share information across the government had greatly expanded the universe of government employees and outside contractors with access to highly classified intelligence. 

“In past years, someone like Snowden may not have had access to briefings detailing these collection programs,” said Cedric Leighton, a former deputy director of the National Security Agency, “but now with the push from a ‘need to know’ to a ‘need to share’ philosophy, it’s far more likely for an I.T. contractor like him to gain access to such documents.”

Snowden worked for the mega-intelligence services firm Booz Allen, which earns over a billion dollars a year in mostly intelligence-related work for the federal government.  Which suggests the second variant:

What Snowden sees, what Obama sees

Edward Snowden,the whistleblower on the NSA's surveillance programs, is brave, serious-minded, and capable, and was very selective in what he exposed, determined not to endanger individuals. I am glad he revealed what he did, to paraphrase James Fallows, though I'm not yet sure what I think the government ought to refrain from doing in its efforts to thwart terrorist plots. I just want to take a second to try to hold two ideas in the mind at once.

The first is this, from Snowden, in an exchange with Washington Post reporter Barton Gellman (Gellman's debriefing is a  remarkable read, as is a Q&A between Snowden and his contacts at the Guardian). Asked, "Did he impute evil motives to his former colleagues, or the White House?", Snowden responded:

“Analysts (and government in general) aren’t bad guys, and they don’t want to think of themselves as such,” he replied. But he said they labored under a false premise that “if a surveillance program produces information of value, it legitimizes it."