Not sure. Ezra Klein criticizes Howard Dean's opposition to the current Senate bill by saying that there will be cost controls through the prudent purchaser limits in the exchanges:
What's so strange about Dean's objection is that the exchanges in
the Senate bill (pdf) do act as "prudent purchasers," that is to say,
they set limits on the plans that can enter in the exchange to ensure
that people are getting good choices. The relevant section begins on
page 131 of the Senate bill. "The Secretary shall, by regulation,
establish criteria for the certification of health plans as qualified
health plans." A couple of pages of relevant criteria follow, including
marketing requirements (plans can be disqualified for focusing their
marketing in outlets that would bring them uncommonly healthy
enrollees), broad provider networks, coverage of options used by
low-income folks (community health centers, say), quality measures,
quality improvement strategies, consumer ratings, standardized benefit
packages, etc.
We need to understand better how this works and what latitude the
insurance companies will have to pressure the exchanges to their
advantage. But if this is, in fact, a robust way to insure
individuals, especially older people with pre-existing conditions in a
way that will enable them to find affordable, good-quality insurance,
my fundamental problem with the bill might be resolved.
But I'm dubious about "robustness."
The question is where the real leverage will lie–with the exchanges or with the insurance companies. The exchanges can't dictate
what the rates and provisions are; they will have to negotiate them
with the insurance companies. Even if this starts out reasonably, the
government-sponsored exchanges can be pressured by the insurance
companies far more easily than if the government just offered its own
insurance that people could choose if they didn't like what was on the
market. And just wait until the Republicans get back into power.
They'll remove whatever "limits" might have been in place in the exchanges' criteria.
But I'm
open to be persuaded on this point. The question remains: is this better or worse than nothing–is it a net positive or a net negative? I don't think it's at all clear yet.
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UPDATE: On the other hand do the exchange limitations provide remedies for the problems identified here by Swellsman at Balloon Juice?
As I understand it, the problem isn’t with our health care, it’s with Americans’ lack of access to health care—which is provided almost exclusive through private insurance companies. Too many people can’t get health insurance because they have a “pre-existing condition.” Too many who otherwise qualify for health insurance can’t afford it. Too many people who can scrape together enough for health insurance find out that when they get sick, they get dropped (“Sorry you developed leukemia at 40—after paying premiums for 20 years—but you failed to disclose that when you were 13 you took steroids for an acne problem. Rescission!”). Too many people who have health insurance, get sick, and don’t get dropped find out that what they have isn’t covered (maternity care is great for this) or that they can’t afford the deductibles and co-pays. Etc. Etc. Etc.
Liberals recognize that a single-payer system makes the most sense, but pragmatically realize you really can’t destroy overnight an industry that makes up so much our our economy. So that’s out, but what do we get instead?
Will Congress get rid of the antitrust exemption, so that health insurance companies will be forced to compete against themselves to provide better service and lower prices (the way the “free market” is supposed to work)?
No.
Will Congress create a non-profit, governmentally run insurance system against which these monopolies will be forced to compete . . . even if only a small percentage of the population will be allowed to take advantage of it?
No.
Can we get, say, an “opt-out” public option?
No.
Can we at least expand Medicate to those 55 an over, the older people most at risk of finding themselves unable to obtain affordable health insurance if, say, they lose their jobs during a recession?
No.
Can we at least lower drug prices by allowing the re-importation of prescription drugs from industrialized countries—like Obama said he wanted to do when he campaigned?
No.
Can we re-import drugs from countries if the FDA goes and certifies that the source of those drugs makes them safe for our use (which, realistically will never happen)?
No.
Can we legislate a fixed percentage of all premium monies must be spent on providing health care coverage, and not go to compensation or profit or marketing?
No.
So what do we get? We can force millions of Americans to purchase insurance policies from private entities who operate as monopolies and therefore can charge monopolistic prices, and we can do so by the threat of force (do it, or pay a fine, or go to jail for refusing to pay the fine).
Well, can we regulate the industry, so they don’t raise the prices and gouge all these new consumers?No.
Can we stop them from rescinding their insurance policies if the consumer gets sick later?
Yes, but not in cases of fraud or misrepresentation—exatly the system we have now.
How can we force people to buy insurance that they can’t afford now?
We can give them government subsidies.
Can we regulate insurance companies so that they don’t raise premiums in order to suck up all these subsidies for their own profits?
No.
I mean . . . seriously. Given all the ways to reform the insurance industry that are now “non-starters,” how the hell is what’s left anything but a big sloppy kiss to the same insurance industry that everybody hates.
And why do the Dems think that it is more important to “pass something,” even if that “something” is only going to make the situation worse?
What am I missing here? I’d really like to know. (Source)
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