THE COMPANY STORE WILL NOT OWN MY SOUL. Representative Paul Ryan (R-Wisconsin) gave a radio interview in which he noted that the authority to determine reimbursement rates would be vested in the Secretary of Health and Human Services (it's just a matter of time before Welfare gets Cabinet status the way Education once did) under the Democratic bill supposedly to be voted on this weekend.

Under the proposal, the Department of Health potentially becomes a monopsonist. (The skeptics tend to take that position, the proponents aren't persuaded.) A monopsony can improve resource allocation in a bilateral monopoly situation, although the applicability of that model to medicine is limited by the ability of physicians to opt out.

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