home

BaucusCare: Ezra Raves About Exchange Provisions, The Magic Of the Market And Gov't Regulation

Ezra focuses on the exchange provision:

Color me impressed. I've argued before that the Health Insurance Exchanges are the most important piece of health-care reform, and they're being unacceptably weakened and constrained. The House bill, for instance, specifically allows businesses with only 20 or fewer people to join.

[. . . BaucusCare call for that], by 2022, the Health Insurance Exchanges will be open to all businesses of all sizes. That's a huge deal. And the first place where I've seen the Baucus bill go substantially further than the other bills.

Color me unimpressed. Ezra's argument for thinking exchanges are the biggest thing:

If I had to choose the most important aspect of health reform, it wouldn't be the public plan. Nor would it be the individual mandate, or the employer mandate, or the employer tax exclusion, or the Medicaid expansion. It wouldn't, in fact, be any of the issues that are dominating the political conversation. Rather, it would be the Health Insurance Exchange.

. . . The vehicle for that promise [of health care reform] is the Health Insurance Exchange. Imagine that you decided you didn't like your current health insurance and you wanted to change it. Your employer very likely doesn't offer any alternatives. If you do have a choice, it's almost certainly not between more than three different plans.

. . . The Health Insurance Exchange gives you another option. Unlike your employer, it will have a wide array of competing providers offering different plans with varying benefit levels, emphases and price tags. Unlike the individual market, insurers won't be able to discriminate based on your health history or your future risk. Plans will have to be certified as meeting a minimum level of comprehensiveness. Plans that routinely screw over members will lose customers to competing insurers. The Health Insurance Exchange, combines the benefits of choice that are theoretically available on the individual market with the bargaining power and scale that's generally accessible only in large employers (and the exchange will, in theory, have more bargaining power than even the largest employers, as it will have a much larger base of customers). . .

And what happens when you introduce productive competition, efficiencies of scale, more innovation and increased consumer power into a market as dysfunctional as the current situation for health insurance? In theory, you get lower prices and higher quality. And if the Health Insurance Exchange has lower prices and higher quality, more individuals will use it and more companies will buy into it. And if that happens, then the efficiencies of scale should increase, and so should the pace of innovation (as the rewards will be greater with more customers), and so the Health Insurance Exchange should further outpace the other markets, thereby attracting yet more customers, thereby further accelerating the virtuous cycle. Eventually, it could become the country's primary insurance market.

Under this theory, the magic of the market, as embodied by a Health Insurance Exchange, will fix health care and insurance. This seems fanciful to me and there is absolutely no evidence that supports this theory.

Here is the basic problem - it requires immense and rigorous regulation of the insurance industry. In the end, the absence of a public option means you are counting on the government regulatory apparatus to do a good job on insurance.

This is unrealistic in my opinion. But I think there is clarity now from Ezra Klein. He really does not care about much else but the exchange idea and, to a lesser extent, subsidies. That's a fair position to take. I think it is wrong and that it would lead to disaster. Respectful disagreement.

That said, then Ezra should NOT object to the stripping of the mandates from health care reform. Let "reform," for now, be exchanges and increase in Medicaid coverage. Let's leave the "real reform" to a different bill. In other words, no public option, then no mandates.

Speaking for me only

< BaucusCare: FUBAR | Health Care Reform And Obama's Theory Of Change >
  • The Online Magazine with Liberal coverage of crime-related political and injustice news

  • Contribute To TalkLeft


  • Display: Sort:
    Lunatics rave. (5.00 / 1) (#1)
    by scribe on Wed Sep 16, 2009 at 10:41:08 AM EST
    I guess that means you, Ezra.

    I don't mind hating on Ezra (1.00 / 1) (#32)
    by jerry on Wed Sep 16, 2009 at 01:31:26 PM EST
    but calling him a lunatic, leaving it at that, and then getting a good comment 5 attached to it?

    That's not the TL I know.

    Parent

    Stop trying to pick fights (none / 0) (#35)
    by Big Tent Democrat on Wed Sep 16, 2009 at 02:04:58 PM EST
    No one called him a lunatic.

    Parent
    I agree with Jerry (none / 0) (#36)
    by Steve M on Wed Sep 16, 2009 at 02:30:56 PM EST
    you have done valuable work by singling out Ezra's role in this debate, but an unfortunate byproduct is that a decent chunk of the comment section on any Ezra post is devoted to comments that are nothing but personal invective directed at Ezra, period.  Just scan down this thread or any other one.

    The posts are about WHY Ezra is wrong but many of the comments are just about how he sucks, he's an idiot, he needs to shut up, etc.  Not really in the spirit of TL in my view.

    Parent

    Is Ezra here? (none / 0) (#37)
    by Big Tent Democrat on Wed Sep 16, 2009 at 02:35:19 PM EST
    Come now.

    There will be 2 civility cops at Talk Left - Jeralyn and me.

    There will be no one else commenting in civility or ratings in my threads but Jeralyn and me.

    It really is quite easy to ignore comments that are not directed at you or about you personally.

    I suggest you and Jerry do that.

    Parent

    Okay (none / 0) (#42)
    by Steve M on Wed Sep 16, 2009 at 03:05:23 PM EST
    I was planning to leave that as my one and only meta comment so there is no need to get all stern.

    Some days I find I need to take a break from TL because all the personal negativity gets enervating after a while.  This is just reader feedback.

    Parent

    Scribe just called him a lunatic! (none / 0) (#53)
    by jerry on Wed Sep 16, 2009 at 05:04:17 PM EST
    Come on (none / 0) (#54)
    by Big Tent Democrat on Wed Sep 16, 2009 at 08:08:05 PM EST
    He did not literally mean it.

    If you do not know Scribe by now, get acquainted.

    Parent

    jerry's comment is partly about me, (none / 0) (#57)
    by Spamlet on Wed Sep 16, 2009 at 10:22:37 PM EST
    since I gave the 5 rating to scribe's comment, so I take it BTD's rules allow me to reply.

    I agree with you, jerry. Too often these days I just hit the 5 button if something amuses me, without stopping to think about whether the comment has accomplished anything else. (This is not a criticism of scribe's comment, just an acknowledgment of my own behavior.)

    BTD says ratings are meaningless, but I see that behavior around ratings can alter the tone of TL in disagreeable ways. Mea culpa.

    I'll add that commenters in general seem a bit cranky or otherwise on edge as health care reform continues to play out toward its uncertain, very freighted denouement.

    Parent

    Again (5.00 / 2) (#2)
    by lilburro on Wed Sep 16, 2009 at 10:50:30 AM EST
    you wonder what Ezra is trying to accomplish with his columns.  He's going to go on TV and end up flattering the hell out of the Baucus Plan.  And throw in an aside about how it's too cheap to work successfully.

    It's like he's standing in a pool of sh*t and saying, "Look at the beautiful sky!"

    wapo (5.00 / 1) (#3)
    by Turkana on Wed Sep 16, 2009 at 10:50:33 AM EST
    ezra. perfect.

    Disagree (5.00 / 6) (#4)
    by waldenpond on Wed Sep 16, 2009 at 10:54:15 AM EST
    I so disagree with his expectation that market forces will resolve this.  Market forces are not working in this country.  I envision the same few insurers controlling the market with small insurers popping up to sell crap insurance and then bundling the crap policies and selling them off (a new special innovation of the market.)  This bill is merely an enrtrenchment of everything that is wrong with health care in this country.  It is appalling.

    Does he really believe this? (5.00 / 3) (#5)
    by nycstray on Wed Sep 16, 2009 at 10:56:57 AM EST
    maybe I'm just too jaded but . . .

    Plans that routinely screw over members will lose customers to competing insurers.

    Who's to say most of them won't be routinely screwing us?

    And again... (5.00 / 2) (#8)
    by Fabian on Wed Sep 16, 2009 at 11:12:28 AM EST
    Health insurance isn't like buying a car.  If you get screwed, you are SOL.  Not only are you out money, but you've either delayed or declined to get actual health CARE because of the insurer's decision not to pay, or you have bills that the insurer won't pay.  

    Will there be any way to compensate consumers who get "scr_wed"?  Or will the insurance companies laugh all the way to the bank?

    BTD is right - without some serious, active regulation of the insurance companies, the consumer is at their mercy.  

    Parent

    Regulation? (5.00 / 1) (#11)
    by nycstray on Wed Sep 16, 2009 at 11:16:28 AM EST
    Wouldn't that require the "skills" of the same people who are screwing us on this bill?

    Parent
    Please, don't remind me. (none / 0) (#13)
    by Fabian on Wed Sep 16, 2009 at 11:23:49 AM EST
    Those oiks would probably figure out that they needed regulation after the first class action lawsuit or first felony conviction of an insurance CEO.

    (Had a local company go under and many execs convicted this year.  Turns out they were running a pyramid scheme instead of an insurance company.  A lot of people and businesses were hurt.)

    Parent

    Keep the faith, please. Hear Phil Angelides (none / 0) (#18)
    by oculus on Wed Sep 16, 2009 at 11:43:08 AM EST
    on NPR's Marketplace yesterday.  He is former state treasurer of CA.  Head of committee just now investigating why Lehman Bros. went under etc.  

    Parent
    Silly Ezra... (5.00 / 1) (#6)
    by masslib on Wed Sep 16, 2009 at 10:57:02 AM EST
    Exchanges are costly, redundant bureaucracies.  Further, he completely avoids the obvious, insurers collude. This legislation is almost built to fail in the long term.

    And insurers collude with government (5.00 / 3) (#15)
    by Pacific John on Wed Sep 16, 2009 at 11:26:57 AM EST
    You can bet that barriers to enrollment would keep people stuck in plans, and marketing would obscure price and quality.

    Health insurance is not by nature a liquid market. If you have a choice, you pick what you hope is your best option, but do not find out about problems like denied claims, holes in coverage or unexpected costs until you get sick or get screwed by premiums. This might take years until you get exasperated and dig into the marketing cra*p to pick a new provider, and then wait until an enrollment window.

    Parent

    Don't you think once the average (none / 0) (#7)
    by oculus on Wed Sep 16, 2009 at 11:11:44 AM EST
    citizen digests this plan Congress will be deluged with people saying don't you dare impose this on me?

    Parent
    I don't know... (5.00 / 1) (#10)
    by masslib on Wed Sep 16, 2009 at 11:15:01 AM EST
    They fooled us with this in MA.  For people with really good employer insurance, they may think this will help those without.  It won't.  But, it can be made to look like it will, until it doesn't.

    Parent
    was the MA unemployment rate much (none / 0) (#12)
    by oculus on Wed Sep 16, 2009 at 11:19:03 AM EST
    lower when MA mandates were imposed?  So many people are either unemployed, working for less money, working less hours, or afraid they too will be unemployed very soon--and w/o access to employer insur. options.

    Parent
    Oh yes... (none / 0) (#14)
    by masslib on Wed Sep 16, 2009 at 11:24:57 AM EST
    Yes, it was, and we have always had the lowest uninsured rates in the country.

    Parent
    Average citizens don't "digest (none / 0) (#23)
    by oldpro on Wed Sep 16, 2009 at 12:19:47 PM EST
    plans."  Wonks digest plans.

    Parent
    I should have sd. plans will be digested (none / 0) (#28)
    by oculus on Wed Sep 16, 2009 at 12:40:44 PM EST
    on behalf of the average citizen.  MSM.  NYT.  Ezra.  Etc.

    Parent
    Nah. Chew...but don't swallow. (none / 0) (#34)
    by oldpro on Wed Sep 16, 2009 at 01:41:25 PM EST
    It's indigestible.

    Parent
    Ezra reminds me of a 17 year old (5.00 / 7) (#9)
    by Pacific John on Wed Sep 16, 2009 at 11:14:09 AM EST
    who just read Atlas Shrugged and is sure he discovered something new about markets.

    Ezra IS ... (5.00 / 3) (#21)
    by Robot Porter on Wed Sep 16, 2009 at 12:02:09 PM EST
    that 17 year-old.

    In fact, he's very easy to understand if you just consider him an Objectivist.

    He fits nicely in that cubbyhole.

    Because everything he does is driven by aggressive self-interest or a ham-handed defense of laissez faire capitalism.

    It also explains why he's such a bad writer.

    Parent

    Stick the the substance (none / 0) (#39)
    by Big Tent Democrat on Wed Sep 16, 2009 at 02:37:49 PM EST
    Sorry ... (none / 0) (#40)
    by Robot Porter on Wed Sep 16, 2009 at 02:57:28 PM EST
    Erza idiocy gets to me sometimes.

    Parent
    For the record (none / 0) (#38)
    by Big Tent Democrat on Wed Sep 16, 2009 at 02:37:34 PM EST
    I do not agree with this comment.

    I do think Ezra's analysis on this is absurd.

    So let's stick to the issues.

    I do not want to be a civility cop. Hell I won't be.

    I will delete non-substantive comments and comments about non-substantive comments.

    Parent

    BTD, you don't agree with a comment? ;) (5.00 / 2) (#44)
    by Pacific John on Wed Sep 16, 2009 at 03:07:45 PM EST
    I wish it could have attached my other comment in the thread for context. Ezra is a very bright guy, but everything is theory to him. He notably became a health care wonk mostly by reading the accounts of the 1993 battle - as he was much too young to remember the actual events. That's quite an accomplishment, I'm not sure I can think of anyone else who has been talented enough to do something like this.

    But because Ezra does not have direct experience, he energetically latches onto theoretical solutions that he would be skeptical of had he seen Pete Wilson's purchasing pool scheme, or heck, if like me, he continually needs to shop for benefits for his employees because the insurance companies are always innovating the next scam faster than consumers can figure them out.

    Business people who already shop for benefits already do what Ezra wants individuals to be able to do... but guess what, individuals aren't up to it, the subject is too complex. Ezra is proposing for healthcare something similar to what Bush did for Social Security, that individuals shop the for the best financial product, or in this case, the best insurance. If those of us who already do this professionally can't drive down prices, what chance does the general public have?

    The most notable aspect of a more fluid healtcare market in which there are no simple options will be that corporations run circles around stressed out consumers. It's likely this would be second nature to Klein if he had real world experience.

    Parent

    He's expecting the Health Exchanges... (5.00 / 1) (#16)
    by gtesta on Wed Sep 16, 2009 at 11:31:56 AM EST
    to be a counter weight to the stock market.  In the stock market, corporations are expected to maximize profit.  Those who don't, see their stock prices decline and become targets of acquisition for those corporations who do maximize profit.
    His expectation is not realistic.

    Regulation v. competition (5.00 / 9) (#17)
    by Democratic Cat on Wed Sep 16, 2009 at 11:34:59 AM EST
    In the end, the absence of a public option means you are counting on the government regulatory apparatus to do a good job on insurance.

    Would these be the same regulators that were watching over the financial industry?  What could possibly go wrong?

    It is ironic that a "free market" solution (exchanges) would depend upon regulation to make it work, whereas a "government solution" (public option) would rely upon competition to make it work.

    One of the barriers to enrollment (5.00 / 5) (#19)
    by TeresaInSnow2 on Wed Sep 16, 2009 at 11:57:02 AM EST
    in health insurance exchanges is if you don't like you're employers' health insurance plan, you have to fork out the cash yourself to buy insurance individually in the exchange.  This isn't a plan for the lower middle class....

    One of the things that keeps employer health coverage low(er) is the size of the group.  Therefore, if employees start going to the exchange, the employer-paid premiums would go up and the incentive would be to stop funding employees' insurance.  This would increase costs for all employees.


    Honestly, reading Ezra is like (5.00 / 6) (#20)
    by Anne on Wed Sep 16, 2009 at 12:01:27 PM EST
    picking at a scab - you know it's going to hurt and you know you're going to be sorry you did it, but you do it anyway.  Oy.

    Ezra needs to get out of the spiffy WaPo-Washington-Beltway bubble and talk to real people about real experiences with health insurance.  He needs to talk to regulators in the states, and to those who lived the Califormia Exchange experiment, and to lots of people in Massachusetts.  He needs to talk to health care providers - hell, he needs to read the newspaper he works for, which last week wrote up half a dozen profiles of individuals and families and their health care/health insurance experience.

    I have no doubt he's an intelligent person, but he is in over his head on this issue; smart isn't everything.  Lately, I have felt like he is auditioning for a job in the administration, and forgetting that it isn't his job to sell us on the administration's or the Senate's policy, but to dig into and expose the flaws and problems and get answers for the real people who will be affected by whatever happens.

    Yes, I know he's not a hard news reporter - are there any of those left? - but Ezra is perilously close to being little more than a shill - which I'm sure is useful to those for whom he is shilling, but for me?  Not so much.


    I respectfully disgree (5.00 / 1) (#27)
    by Spamlet on Wed Sep 16, 2009 at 12:31:32 PM EST
    Ezra needs to get out of the spiffy WaPo-Washington-Beltway bubble and talk to real people about real experiences with health insurance. He needs to talk to regulators in the states, and to those who lived the Califormia Exchange experiment, and to lots of people in Massachusetts. He needs to talk to health care providers . . .

    Ezra needs to STFU.

    Parent

    Perhaps I should have said that (5.00 / 2) (#31)
    by Anne on Wed Sep 16, 2009 at 01:23:58 PM EST
    Ezra needs to listen more and talk/write less.

    He could genuinely benefit from listening for a good long while.

    Parent

    When I recently googled health care reform (none / 0) (#29)
    by oculus on Wed Sep 16, 2009 at 12:43:42 PM EST
    the first hits were to Ezra.  Not sure how he became the go-to guy on this issue, but there you have it.  Yes, I do know google search is rigged, but still.

    Parent
    Ezra became a genuine expert (5.00 / 2) (#45)
    by Pacific John on Wed Sep 16, 2009 at 03:19:22 PM EST
    a number of months before the Dem primary with some very good writing on the subject. He filled an information gap for newer wonks and activists, since long time experts like Uwe Reinhardt aren't plugged into blogs.

    And make no mistake, his pre-campaign work was excellent. I've been in healthcare professionally for 20 years, and been an activist for almost as long, and Ezra's writing was good enough that I printed it out and passed it around the office.

    But I note your sarcasm, and agree with it. He's not tethered to the grit of the way things work, and he's a lot less objective now that he's playing the Village game.

    Parent

    All I know about Ezra is what I read (none / 0) (#51)
    by oculus on Wed Sep 16, 2009 at 03:52:24 PM EST
    here, so I was surprised he was the most obvious source of info on proposed current legislation.  Thanks for the information.

    Parent
    Absolutely (5.00 / 2) (#25)
    by cal1942 on Wed Sep 16, 2009 at 12:29:56 PM EST
    no public option, then no mandates.

    If mandates are in place with nowhere to go but private insurance, this becomes a massive windfall to private insurers and punishes those who don't qualify for a subsidy but nontheless can't afford the insurance.

    That would be catastrophic and in the long run further shrink the middle class.

    A complete lack of commitment and leadership led to all of this.  Instead of universal coverage we'll probably end up with fattened health insurance companies.  The parasites will triumph.

    That's snatching defeat from the jaws of victory.

    Sounds like a race to the bottom (5.00 / 1) (#26)
    by Spamlet on Wed Sep 16, 2009 at 12:29:58 PM EST
    of the lowest-common-denominator pool.

    Plans will have to be certified as meeting a minimum level of comprehensiveness. Plans that routinely screw over members will lose customers to competing insurers.


    Right, Ezra ... (none / 0) (#56)
    by FreakyBeaky on Wed Sep 16, 2009 at 08:37:16 PM EST
    ... customers screwed over by their insurance companies will go to competing insurers just as soon as they are done paying off their medical debts or declaring bankruptcy ... or dying.  Or being sick or disabled.

    Parent
    One question: (5.00 / 2) (#41)
    by Anne on Wed Sep 16, 2009 at 02:57:49 PM EST
    Has Ezra actually read the Baucus bill - I mean read it from top to bottom?  Marcy Wheeler has been working her way through it, and I have to say that after reading her take, and then reading Ezra, I would be very surprised if he has.

    The details of the Baucus bill are beyond troubling - everything from premiums being paid via payroll deduction:

    For employed individuals who purchase health insurance through a state exchange, the premium payments would be made through payroll deductions.

     to what appears to be an incentive for employers to keep wages low:

    A qualified small employer for this purpose generally would be an employer with no more than 25 fulltime equivalent employees (FTEs) employed during the employer`s taxable year, and whose employees have annual fulltime equivalent wages that average no more than $40,000. However, the full amount of the credit would be available only to an employer with ten or fewer FTEs and whose employees have average annual fulltime equivalent wages from the employer of less than $20,000.

     to the prohibition on government entities from creating co-ops:
    It must not be sponsored by a State, county, or local government, or any government instrumentality.

    to hard-to-interpret language about opt-outs from employer-sponsored plans:
    As a general matter, if an employee is offered employer-provided health insurance coverage, the individual would be ineligible for a low income premium tax credit for health insurance purchased through a state exchange. An employee who is offered coverage that does not have an actuarial value of at least 65 percent or who is offered unaffordable coverage by their employer, however, can be eligible for the tax credit. Unaffordable is defined as 13 percent of the employee`s income. For purposes of determining if coverage is unaffordable, salary reduction contributions would be treated as payments by the employer. The employee would seek an affordability waiver from the state exchange and would have to demonstrate family income and the premium of the lowest cost employer option offered to them. Employees would then present the waiver to the employer. The employer assessment would apply for any employee(s) receiving an affordability waiver. Within five years of implementation, the Secretary must conduct a study to determine if the definition of affordable could be lowered without significantly increasing costs or decreasing employer coverage.

    A Medicaid-eligible individual can always choose to leave the employer`s coverage and enroll in Medicaid. In this circumstance, the employer is not required to pay a fee.

    and:

    Exemptions from the excise tax will be made for individuals where the full premium of the lowest cost option available to them (net of subsidies and employer contribution, if any) exceeds ten percent of their AGI.

    Marcy's take:

    Now, it's a good thing (sort of) that the affordability rate for individuals is 10% of AGI. That means a family would be able to opt out if there were no health care available at even a lower rate than I thought (for example, it might mean a middle class family could opt out if health insurance cost them $6,000 a year, as opposed to $8,000 a year). It's a bad thing, though, because it means MaxTax would be far from universal--a lot of middle class families will pretty much have to opt out because they can't afford coverage.

    But if your employer offers health care--even if it covers just 65% of costs--then you can't opt-out unless you're paying out of pocket 13% of your total income!! Oh, and to opt-out you have to go to your manager and tell him or her that you're opting out, which means the employer will be fined; how many people do you think will be fired rather than opt-out?

    See what I mean?  How could Ezra be so enthusiastic about the exchanges when this kind of detail is part of it?

    Right. Marcy has been screaming... (5.00 / 2) (#46)
    by Pacific John on Wed Sep 16, 2009 at 03:25:36 PM EST
    ... that the Baucus plan would require individuals who currently opt out of cr*p plans like WalMart's  be forced to buy it, even if the plan falls below whatever industry-friendly minimum standards are set.

    I can't imagine why Ezra is missing some of this basic stuff. It's not just inexperience, although that's a big part of it.

    Parent

    I'm confused (none / 0) (#43)
    by Steve M on Wed Sep 16, 2009 at 03:06:58 PM EST
    what's wrong with premiums being paid through payroll deduction?  That's how most people pay their insurance premiums already.

    Parent
    Do you pay your life insurance premiums (none / 0) (#47)
    by Anne on Wed Sep 16, 2009 at 03:25:43 PM EST
    that way?  Any other bills?  No?  Me, either.

    Can you think of any payroll deduction that goes to anything other than a government entity?  Yes, you might, as I do, have part of your pay direct-deposited to a savings account, and you might be making an automatic 401(k) contribution, but those are "deductions" that are really payments to yourself.

    How nice for the insurance companies participating in the exchange if the premiums for those with jobs can be zapped directly from their pay.

    I hope that's not all you're confused about, because that, to me, seems like the least confusing aspect of all of this.  Less confusing, even if not less troubling.

    Parent

    I'm not following you (none / 0) (#48)
    by Steve M on Wed Sep 16, 2009 at 03:28:46 PM EST
    my health insurance premiums don't go to a government entity - they go to United Health Care - but I never see that money.  It comes straight out of my paycheck.  Same for everyone else at my company, and pretty much every other company that provides health coverage, as far as I know.

    Parent
    Perhaps you are right, Steve. (5.00 / 1) (#50)
    by Anne on Wed Sep 16, 2009 at 03:49:19 PM EST
    If payroll deduction is the method of payment for small businesses that purchase insurance through the exchange, it really would be the same as what businesses do now.  

    But, what I excerpted refers to employed individuals who purchase insurance through the exchange - and that was my point: does your employer facilitate any payment on your behalf via payroll deduction to any other provider that your employer is not associated with?  I mean, suppose you would prefer to pay your premiums yourself?  Why would you, as a private citizen buying a product from a private company, be required to pay via payroll deduction?

    [As an aside, I would be very surprised if your premium went directly to UHC; I imagine your employer is withholding your premium - along with the premiums for your co-workers - and holding it in an account from which the entire group premium is paid by your employer on a monthly or quarterly basis - especially if you and your employer are sharing the cost of the coverage.]


    Parent

    Right (none / 0) (#52)
    by Steve M on Wed Sep 16, 2009 at 04:43:39 PM EST
    but my point is, the fact that you never actually see the money that goes to pay your health insurance premiums is a normal fact of life for most Americans, and I don't see what's disturbing about the fact that it would continue to work this way under the exchange proposal.

    Of all the possible objections out there I'm just really not following this one.

    Parent

    Same here. (none / 0) (#49)
    by oculus on Wed Sep 16, 2009 at 03:43:23 PM EST
    The Wealthcare Mess (none / 0) (#22)
    by cwolf on Wed Sep 16, 2009 at 12:09:15 PM EST
    I don't give a rats ass about the cost,,,

    I want Prices to matter most

    I love this little bit from ezinearticles

    The French are very dismissive of the British system which they call "socialized medicine." Virtually all physicians in France participate in the nation's public health insurance

    I love the cop out.... (none / 0) (#24)
    by oldpro on Wed Sep 16, 2009 at 12:27:14 PM EST
    After the long slow curve, comes the fast break:  it's only a theory!  No guarantees that it will work!

    What the Hell?  That's the best ya got, Ezra?

    Color me suspicious (none / 0) (#30)
    by ruffian on Wed Sep 16, 2009 at 01:04:38 PM EST
    Is he saying that the proposed new regulations for insurance companies not being able to reject people for pre-existing conditions, or taking away the insurance when people make claims, only apply to companies participating in the Exchange? I thought those rules were to be across the board. Is the Exchange itself the regulatory apparatus? If not, it is no more useful than the current ehealthinsurance.com shopping market.

    If it is, as Ezra implies, the wellspring from which all insurance goodness flows, it does explain why the Exchange is the only thing Obama has consistently said will be in the plan. It msut be part of the deal he made with insurance companies to get them to accept the regulations. The real Exchange is this: insurance companies accept regulations in Exchange for the government bringing them customers

    I don't understand how it is ... (none / 0) (#55)
    by FreakyBeaky on Wed Sep 16, 2009 at 08:33:07 PM EST
    ... that so many Americans simply do not understand capitalism and the free market.  You charge the highest price for your product or service that the market will bear.  You put any extra dollars from increased efficiencies and economies of scale into your pocket.  You do NOT, if you can possibly help it, pass them on to your customers in the form of lower prices, although competition might force you to give a little back that way (in a real market, not the so-called  "market" for health insurance).  That's giving money away, why, it's practically Communism!  Nobody is in business to give money away.  Why do guys like Ezra Klein not get that?

    If health insurance were not such a weird business, where your most profitable customers are the ones that use your product the least, and the ones who need it KILL YOU, it might work - but then we wouldn't even be having this conversation.