When small, independent providers want to
negotiate with multiple health plans, large
insurers exert enormous pressure to stop them.
The statewide trade group for doctors in New
York sued UnitedHealth Group Inc., the nation’s
second-largest health insurer by enrollment, for
allegedly using illegal coercion in just such a
scheme to limit competition.26
In a separate matter UnitedHealth agreed to pay
$400 million to settle multiple suits alleging
price fixing and other anti-competitive
Much of this debate reflects differences in analysis scope (Litman 2009b). Highway
expansion advocates tend to focus on traffic congestion reduction objectives and ignore
the negative effects of induced vehicle travel and sprawl.
Advocates of investments in
alternative modes tend to consider a wider range of impacts and objectives, including
traffic congestion reduction, parking cost savings, consumer cost savings, accident
reductions, improved mobility for non-drivers, energy conservation, pollution reductions,
and public fitness and health.
Livestock was reared mostly in rural areas while milk and milk
products were consumed both in rural and urban areas. Because the
marketable surplus of milk available with individual farmers was too small
to justify a trip to the nearest town, it was sold to middlemen who often
exploited the farmers by charging an amount in excess of the cost of their
services, reducing farmers’ returns on the one hand and charging higher
prices to the consumers on the other. The Plan document noted that some
milk production also took place in ‘congested and insanitary pockets by
The maintenance of road pavements in England has become a costly necessity, due largely to the large volume of commercial vehicles using the roads which cause pavements to deteriorate quickly, and makes their repair more difficult to carry out. These roadworks incur not only direct works costs, but also indirect costs from factors such as congestion, motor accidents and pollution. There is obviously a need for cost-effective maintenance that minimises the occurrence and duration of these disruptions.
Distance-based insurance reflects the principle that prices should be based on costs. It
gives consumers a new way to save money by returning to individual motorists the
insurance cost savings that result when they drive less. Motorists who continue their
current mileage would be no worse off on average then they are now (excepting any
additional transaction costs), while those who reduce their mileage save money.
Distance-based pricing can help achieve several public policy goals including actuarial
accuracy, equity, affordability, road safety, consumer savings and choice.