Competing to death: California's high-risk system

Competition in California has cost lives and money. Shifting care out of hospitals reduced hospital spending relative to other states, but overall health spending per capita rose to the second highest in the nation in 1990. High spending coexists with low rates of coverage--the state ranks seventh in percentage of people lacking insurance. Hospitals have closed emergency rooms and other unprofitable services while marketing duplicative and often unnecessary services to the well-insured. With real free markets unattainable in health care, California's competitive rhetoric has rationalized growing inequalities and higher costs. The market's invisible hand has picked Californians' pockets and endangered both rich and poor.