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Politics : View from the Center and Left -- Ignore unavailable to you. Want to Upgrade?

To: JohnM who wrote (131663)	2/27/2010 7:39:58 AM
From: Lane3	Read Replies (1) \| Respond to of 541348

We were talking about regulating private insurance companies in the exchange. Not medicare. I was not changing the subject to Medicare. I was responding to your point: "Both the health industry and the healthcare insurance industry remain private but regulated." I was countering the notion that the exchange will operate as a private but regulated insurance industry model as you keep insisting. I used Medicare to illustrate my point rather than the exchange because that is extant, not proposed, thus more solid and easier to convey. Medicare and the exchange are effectively the same for purpose of the point I was making, which was about the paradigm in which the government entity and private entity interact, so I chose to write about it in terms of Medicare rather than the exchange. If it is less distracting for you, go back and substitute "exchange" for "Medicare." I thought I was making it easier but maybe not. Medicare and the exchange are effectively the same in terms of my illustration of the basic paradigm shift. In both cases you have a government function. Medicare and the "exchange" are owned and operated by the government based on legislation. Government makes the rules and there is a bureaucracy to run the program. Both decide what will be covered and what won't be, who is eligible and who isn't, who (customer) pays what to participate. The private entity merely handles the paperwork. This relationship is most like that of the government outsourcing its work. It is not like the private insurance industry where insurance companies decide what products to offer and who is eligible, prices and markets the products, makes the decisions, etc. An outsourced function uses contract workers rather than government employees but the contractor isn't the insurance industry. It's the manpower-and-administration-on-behalf-of-the-government aggregator industry. I don't think that framing this as regulation of the insurance industry is valid. We have moved away from that. We are moving in small increments. Like the water in the frog's pot, the shift in paradigm is going unnoticed. If we're not paying attention, we can maintain the fiction that with Medicare and the exchange we still have an insurance industry but what we have now with Medicare and will have with the exchange is closer to the UK's NHS than it is to a private insurance industry. If it were an actual exchange for a private insurance industry, it would be a place where insurance companies still decided what products to sell at what prices, who would be approved, etc, and the exchange would just a place where the particulars were arrayed so customers could easily compare the products and choose among them. I would much prefer an expansion of medicare to cover the 55 and up bracket. Actually, I would, too. It would be cleaner and more efficient. I hate these paradigm distortions. So unkempt. So misleading. Being in virgin territory without recognizing that one has crossed the boundary to the unknown is ripe for unintended consequences.