Wyden says, "the area that i would like to be bolder in is in this area of creating a market through choice and competition."As long as we're on this topic, I'm highly skeptical of the "choice and competition" talking point that Obama and Democrats have picked up on. Many employers offer multiple plans to their employees, and employees then choose the plan they wish to buy into. Employers who do this are effectively creating on a very small scale something we can call an "insurance exchange," as has been proposed in every bill on a much larger scale. Personally I have never met someone who, when given such a choice has any clue what they're choosing. People will get a choice, and businesses purchasing plans off the exchange will have a choice, but there's no reason to believe that they will make an economically rational one given the way insurance plans are presented. In High School my mom once changed plans at Washington State University because one of them offered better coverage for the asthma medication Advair, which our original insurance plan didn't want to cover, but was doing an incredible job of controlling my asthma. That was an awfully narrow consideration, that if you're able to do an in depth cost benefit analysis of the two plans, might not actually be worth it. However, since health care plans are unreadable for most people, consumers will make choices like the one my mom made rather than really figuring out which plan offers the better deal holistically. I think we need reform badly enough that I'm willing to get behind a strong health insurance exchange, but I'm pretty skeptical that it can actually work, even educated and informed consumers are going to be unable to distinguish between plans and will choose based on pretty narrow criteria. Wyden's other concern was related to the tax on health care companies that forms a central part of the Baucus cop out plan, and was endorsed by Obama the other night.
Wyden believes the proposal wouldn't allow nearly as many people as it should to choose to enter so-called health insurance exchanges, if they're unhappy with the insurance their employers provide.
"Only people who are unemployed and uninsured and work at very small businesses would be allowed choice and competition in the exchanges," Wyden noted "Anybody who works at a mid-size business who doesn't like what they have, a government bureaucrat steps in and says you don't have choices.
But Wyden was perhaps most critical of the financing scheme--enshrined in the Baucus plan, and endorsed by Obama--to raise the funds needed to pay for the bill by taxing high-end private insurance plans. That measure sells politically--who doesn't like the idea of taxing insurance companies?--but the incidence of the tax is likely to befall insurance consumers, including middle class Americans who Obama vowed not to increase taxes on.Everything I've read on the topic of this type of a financing scheme agrees that the costs will just be passed on to consumers. Given the realities of American health care that's just not a productive outcome. I think Wyden is spot on here, and hopefully we can come up with a better way to finance this.
"This financing system is not my first choice," Wyden said. "We're going to be working in the finance committee to address the concerns you describe."
I was really relieved at the tone that Wyden seems to take here, he's not playing games with whether he'll support something like what Obama laid out the other night, but he is engaging seriously with the policy and looking for ways to work towards a better bill. As far as the two points I highlighted here, I think Wyden is wrong on the first, but so is Obama, absent a single payer approach however, it makes a lot of sense. And on the second he's spot on. Hopefully Wyden can help improve the Senate bill (whichever one becomes the Senate bill) and cast his vote for universal health care. Now he better not make me regret this post by working against a public option.