Yesterday, a bill passed the US House of Representatives passed a bill by a remarkable margin of 406 to 19. This is not because Democrats have suddenly taken over an extra 150 House seats without your noticing; it is, in fact, because the bill is one following an ages-old American value: Corporate monopolies are bad for business, for consumers, and for workers.
The bill removed an exemption to anti-trust laws that was specially crafted for insurance companies. While states currently have theoretical authority to investigate and block insurance company monopolies, many simply don't: A study by the AMA (pdf) finds that the vast majority of markets are dominated by a single insurer, crossing the usual Department of Justice threshold for market concentration. In some states, a single insurance company writes upwards of 2/3 of the policies.
Here in Wisconsin, 52% of us are insured by WellPoint; in neighboring Iowa, 71% are insured by Wellmark. Across the lake, 65% of Michiganders are insured by Blue Cross. And so on.
One of the 19--all Republicans, by the way--who voted against removing the special protections insurance companies receive was Wisconsin's Paul Ryan. This may have something to do with where his campaign contributions come from, I can't say for sure. But in another way, it kind of surprises me. Ryan professes to be a fan of juvenile philosopher Ayn Rand, whose two-dimensional heroes (and, yes, I've read some of the books) tend to be self-made entrepreneurs who have to struggle for acceptance and success against the reigning corporate or political hegemony. By voting to allow insurance companies to maintain monopoly or monopsony power, Ryan is voting to keep the John Galts of the world shut out of a major sector of the US economy.
All of which just reenforces the pretty clear narrative about Republicans like Paul Ryan: While claiming to be pro-business, they ae actually just pro-existing business. Other health insurance reform measures, like those making it easier for small businesses to offer health insurance to their employees, have been shut down or shouted down by Ryan and his ilk. In return, they offer race-to-the-bottom proposals designed to enrich their corporate sponsors at the expense of working Americans--not something even Ayn Rand would approve of.