To give Ezra credit, he FINALLY addresses some point detractors of this bill make:
Health insurance suffers from market failure in part because it suffers from regulation failure. We're adding the regulations now and we'll see, in 10 years, whether people hate insurers somewhat less, or whether they've embraced the nonprofit model, or whether they're clamoring for public insurance. Either way, putting insurers into a structured market where they'll have to compete against one another and users will rate them should make things a lot better. Public insurance might be the best way forward, but an insurance market that works for consumers is progress nevertheless.
Good to see the admission of regulatory failure. Hard to see the argument for expecting it to succeed now. But, as Ezra says, "we'll see in 10 years."
This part seems fanciful to me:
[P]utting insurers into a structured market where they'll have to compete against one another and users will rate them should make things a lot better.
This is the vaunted exchanges (state based exchanges according to the Senate bill.) The argument seems to be that folks who do not get their insurance from their employer do not shop now. I'm pretty sure they try to. More importantly, "the structure" is rife for collusion, which would be legal by the way, as health insurance companies are exempt from antitrust laws (even if you thought antitrust regulators would be effective in policing them, they can't.)
Finally Ezra's argument that "Public insurance might be the best way forward, but an insurance market that works for consumers is progress nevertheless" misses the mark in two ways, First, the big carrot for political bargaining on health care reform was in fact the mandates and the government subsidies. There will be no second bite at the apple on health care reform. Second, this bill does not create "an insurance market that works for consumers." In the end, this is the dispute - do you believe in these reforms? Is it not fair to say, as Howard Dean does, that they will not and therefore I want to take out the bargaining chip we need to achieve real health care reform?
The Village Blogger argument is that this is all we can get and we will never have another chance again. I think that gets it backwards. Indeed, my argument for sunsetting the mandates is that the ONLY way we can really have another bite at the health care reform apple is if mandates are back in play.
Without the mandates to bargain with, health care reform is dead for a generation.
Speaking for me only
