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Mark Pryor makes the health insurance exchanges a bit more like


Backed by a 98 to 0 vote, Sen. Mark Pryor (D-Ark.) just passed a small amendment that might make a big difference in insurance markets. Pryor's amendment directs "the Department of Health and Human Services [to] establish, gather and post online consumer feedback about the health care plans offered through the proposed health care exchange."

People like to talk about "disruptive technological innovation," and they tend to mean something really major. Steam-powered engines, for instance. But the ubiquity of online product reviews has been among the most important market innovations in recent years. A customer buying a movie on Amazon has a lot more information than one browsing in Wal-Mart. But there's no real equivalent in the health insurance market, despite the fact that the quality of your insurance is a lot more important than the quality of “Underworld 2: Rise of the Lycans.” Comparing a PPO from Aetna and a PPO from Cigna is basically impossible for the average consumer.

Pryor's amendment establishes consumer reviews for the health-care products in the exchange. This is good not just because it gives consumers information, but because it threatens insurance companies. An insurer with low ratings will lose potential customers, not to mention face hard questions from the administrators of the exchanges. It's the sort of thing that could make the exchanges substantially superior to the rest of the insurance market, though it's hard to say how much that'll matter if they remain locked to all but 10 percent of the population.

Photo credit: By Chip Somodevilla/Associated Press

By Ezra Klein  |  December 7, 2009; 4:37 PM ET
Categories:  Health Reform  
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Newt Gingrich and the Center for Health Transformation has been describing it like "Travelocity" for some time. The amazon-esque comment feature will be exploited by bloggers hired by the industry before the exchange launches. Compare the plans using a customer-friendly qualitative and quantitative explanations of actuarial equivalence, and let plan quality data speak for itself.

Posted by: JMOB | December 7, 2009 5:03 PM | Report abuse

So what prevents the insurance company from either directly, or hiring people to write positive reviews on their behalf?

Posted by: nylund | December 7, 2009 5:04 PM | Report abuse

JMOB, nylund, preventing fake ratings is only a technical detail. For instance, at various sites already we have "verified buyer" for ratings, etc. Of course if the rating site is public then it would need administrators that are on the ball, etc. Just brief general language could require verified raters, etc.

I'm encouraged that many of the good ideas are showing up lately in Congressional discussions.

If they couldn't get away with too many pieces of mediocre reform, they might have to actually do rather good reform in several areas (instead of only 2).

Posted by: HalHorvath | December 7, 2009 5:17 PM | Report abuse

Before we get all cynical this could just be an amendment making sure the CAHPS survey ( is used to assess the plans. If so, it's not particularly Amazon-like. Basically a 150 question survey (# of questions vary by customizations) covering all sorts of patient experience items.

Posted by: ThomasEN | December 7, 2009 5:20 PM | Report abuse

Are they going to censor it like Amazon does with its reviews? I gave up posting on Amazon after too many run-ins with the dreaded ellipsis: "This book is really ... good."

It could be a good idea, but I'm not aware that it has been tried before and there are certainly risks. For example chronically ill patients tend to rate their care lower so it could exacerbate risk adjustment issues.

Posted by: bmull | December 7, 2009 5:22 PM | Report abuse

Well as long as people can post WORDS of why the do or do not like their plan it will be good. If its just a numerical rating system its worthless. But it'll be difficult for insurers to hide if there are stories of bad behavior.

Posted by: truth5 | December 7, 2009 5:26 PM | Report abuse

I suspect it will be about as useful as a Yelp restaurant review. A third of the people will claim it's the best food they've ever eaten, a third will claim they'll never go back, and the other third will be divided between shills for the restaurant touting it, and hacks for the restaurant across the street who will be deriding it.

I think that within a given health care company's plans there will be satisfied policy holders and dissatisfied policy holders. For example, we (by dint of work) have Cigna. We, frankly, haven't had a problem with them, but I can assure you that there are probably thousands of people who have. It's going to be tough for consumers.

Posted by: JJenkins2 | December 7, 2009 6:47 PM | Report abuse

This is OK, although the literature is ripe with data demonstrating that there is a poor connection between patients satisfaction and actual quality of care. Instead, patients tend to value the non-medical aspects of health care disproportionately-- personal interactions, access to parking, amenities, etc. So there's real question on the value of consumer input.

That said I'm a huge consumer-directed health proponent generally-- we just need decisions to be made on the right data. Following the NHTSA model on crash safety-- a government-sponsored evaluation system with simple metrics-- five stars-- is where we should be going. An HHS, or NCQA (which already exists) evaluation, coupled with meaningful stats that could be collected-- % of claims disputed/rejected, etc. could provide a consistent 5-10 data points that would be significantly more meaningful than consumer reviews. But this is a step in the right direction.

And I LOVE seeing Ezra profess that consumer reviews could make a "big" difference. Sounds like he's a CDH guy at heart. :)

Posted by: wisewon | December 7, 2009 8:09 PM | Report abuse

the problem is that you could have a good plan and people don't understand it, get burned by it and then they bash it in the review. In fact when was the last time you heard anyone say, "Gee, my insurance company paid over $250,000 of my bills and I have a small amoun to pay, Thanks Aetna." Never happens, never will. Its assumed that we're owed it due to large premiums even though no one would ever pay $250,000 in premium in their lifetime.

Also go out and ask 10 different doctors their feelings on 10 different insurers in regards to payment ease, frequency etc and you'll get 10 different answers. I doubt this will be useful at all and again just a waste of taxpayer money although I would expect (and hope) a small one.

Posted by: visionbrkr | December 7, 2009 9:10 PM | Report abuse

Like JJenkins2, I also immediately thought of comparing its usefulness to that of Yelp restaurant reviews. Which is to say - not useful at all.

Posted by: jlk7e | December 7, 2009 11:25 PM | Report abuse

I'm sure the Department of Health and Human Services will put together a wonderful website. Millions of people will flock there to exchange useful information about different insurance programs, even though they're extremely complex, vary by state, vary by employer, etc. I am fully confident that the computer programmers at the Department are highly paid, highly motivated professionals who turned down jobs at Amazon to work with the very best.

Posted by: ostap666 | December 8, 2009 8:58 AM | Report abuse

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