Reply #15: A national Health Insurance Exchange with at least 20 million participants could 'bend cost curve'

[flpoljunkie]

and be a vehicle to insure the tens of millions who have no insurance.

Ezra Klein has written that Obama would need to get major concessions in order to drop the public option--including more money for subsidies and a much stronger health insurance exchange--but that the public option should only be dropped--if it is truly needed to 'secure passage of the final bill.'

If the public option needs to be dropped to secure passage of the final bill, then that may be the unfortunate reality of the situation. But that's the context in which you drop something like the public option: A context in which you get something significant for the concession, like passage of everything else, or much more money in subsidies and much stronger exchanges. You don't drop it in the hopes that the compromise will be seen by opponents as reasonableness rather than weakness. The public option is good policy and, if it comes down to it, the largest bargaining chip. You don't give it away lightly. But you do have to keep it in perspective.

http://voices.washingtonpost.com/ezra-klein/2009/08/aga...

Klein's column about Health Insurance Exchanges: http://www.washingtonpost.com/wp-dyn/content/article/20...

And, this from Klein on the public option...

The public option is one of them, to be sure, and I think there's a substantial chance it will be present in the final legislation. But what about the expansion of Medicaid to 133 percent of the poverty line? That's a solid 20 million poor Americans who don't have coverage now, and will soon. What about the out-of-pocket caps, so no one goes medically bankrupt ever again? Or the assurance that no insurer can ever discriminate based on a preexisting condition? Or the subsidies for working Americans who can't quite afford coverage? Or the requirements that insurers spend more money on medical care and less money on premiums? Or the guarantee that the gruesome practice of rescission will finally end?

http://voices.washingtonpost.com/ezra-klein/2009/08/be_...

I would wholeheartedly agree on the regulation of the 'medical loss ratio'--the percentage of premiums spent on paying claims. It is about 80 cents today--compared to the early 90's figure of 94 cents paid out in claims (Wendell Potter gave these figures when he appeared on Bill Moyers several weeks ago).

That said, I have no doubt most Republicans would not support a 'national' Health Insurance Exchange. Of course, we do not need all their votes.