OK, not another healthcare diary, but something that steams me just as much these days - mandatory state safety inspections. Unlike New Jersey, Pennsylvania lets the "free market" of private auto inspection stations rule this annual hassle for automobile owners.
Having been in both PA and NJ, I'm very displeased with Pennsylvania's system, for one simple reason - like HMOs, the system is set-up with the profit of the service center in mind, not the consumer/voter.
Pennsylvania stations are free to charge whatever they want for the state-mandate, annual inspections. You can shop around, and definitely should, but if you don't, the private inspectors have every incentive to find any and even make up, repairs needed to pass an inspection. Rates for inspection range from $35 to $100, but almost all inspection stations carry racks of wiper blades - a common easy part to fail an inspection for. Once the shop fails you, you are responsible for fixing the fault and can either return to the same inspection station or pay another $25 to $100 to get inspected elsewhere. Blades that cost $10 if you WANT to buy them suddenly cost $40 when you HAVE to buy them.
The conflict of interest between an inspection stations private business of parts sale and repair and their public job of inspecting vehicles is massive. Why does system survive this way? Just like healthcare reform, the service station owners are a large presence in Pennsylvania - inspections represent over $500 million a year in revenue to the service stations. Any attempt to introduce a single-payer, state run system would deprive stations of this revenue, plus the "extra" revenue they make by selling unnecessary parts and repairs in vehicles.
The state did pay for a cost benefit analysis - the conclusion (the report is here: http://www.dmv.state.pa.us/... is that about 127 lives a year are saved, at a cost of $620 million in direct costs and 16 lives in waiting time (assuming one hour per inspection - pretty optimistic). How many lives would be saved if the state did the inspection? Should be the same.
Do the right thing Pennsylvania - SINGLE PAYER NOW!!!!