Letters to health-care Santa: Let Ron Wyden fix the exchanges!
Over the course of this week, I'll be asking some health-care experts what they'd like Santa to add to the bill during conference committee, and publishing their responses on the blog. Our next payer is Victor Fuchs, the Henry J. Kaiser Jr. Professor of Economics and of Health Research and Policy, emeritus, at Stanford. Fuchs is a member of the Institute of Medicine and was president in 1995, and a distinguished fellow of the American Economic Association.
I would opt for passage of the Wyden-Collins Amendment, which provides vouchers as a new voluntary option for employers and employees to purchase health insurance through the health insurance exchanges. Inclusion of the Wyden-Collins Amendment in the final health bill would strengthen the reform effort in several ways:
1. The employer would save a 6 or 7 percent broker's fee plus internal administrative costs.
2. The employees would have a wider choice of plans and would be free to switch employment without having to change health insurance.
3. The insurance exchanges would work more effectively and efficiently because they would have many more participants.
The key to the success of this arrangement is a well-functioning risk-adjustment system to protect insurance companies against adverse selection. Given such a system, the voluntary option to allow employed persons to use the insurance exchanges is winner all around. (Except the brokers.)
Earlier in this series, Diane Archer called for Congress to create national exchanges rather than state exchanges, Alain Enthoven offered some ideas for how to fix the exchanges, David Cutler proposed a soda tax, Austin Frakt argued for competition in the Medicare Advantage program, Jacob Hacker broached letting the public sector help the private sector negotiate lower rates, George Halvorson tried to expand the exchanges to include providers of actual care rather than just insurance coverage, Henry Aaron wants the death panels back, and Jon Gruber wants the House's definition of decent insurance coverage to prevail.
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