What we need is universal access to a national exchange if any of the market forces are even going to be more than a selling point for rubes.
Two throw away issues for most folks but the only ways for the scheme to actually even have a chance to work and to bear a passing resemblance to what the bill is touted as.
Deleting the bullshit "Cadillac" tax which over time will send us all to bronze land and imposing direct cost controls would be great, maybe even impose MLR's where they can contain cost rather than acting as an incentive to increase them, like on the pharmaceutical companies, durable medical equipment, hospitals, you know where the rubber meets the road rather than just at the purse when the cartel controls the allowable charges and they are below market. The MLR is also set where the industry self reported, there is some elasticity there because there has been some clean up of the definitions and yes there will be rebates but they speak to minimal impact of the signature cost containment element (not wanting to press the other major one much, the aforementioned "Cadillac" tax which is meant to diminish care) because as a percentage of health care dollars they are insignificant.
There are elements that could make a real overhaul but they are not being applied correctly and sometimes willfully hogtied.
I also think the anti-trust exemption has to go, the ability to collude and fix prices is a legitimate threat to make a mockery of the whole effort. Any aspect they don't wish to comply with is a little unity away from being folded on. The cartel has been given too big to fail status and there is no alternative gatekeeper to keep them in line.
Some kind of effort to limit pool fragmentation is critical, any impact of systemic savings will always be minimized especially the fool's gold of the savings from the uninsured being in the system. By the time you pass the nickles through many thousands of fragmented mini-pools and groups it just isn't much bang there.
It may even sound like nit picking but these sort of little seeming adjustments actually demand some rather serious remaking of the wheel.
The biggest appeal to many is "having something to build on" and that is the essential issue the structure is essentially the same shit we have now.
I want a public option, if for no other reason than to impose a systemic check on the cartel so that we have no choice but fold to their united front but it doesn't work save for a dumping ground for undesirables as things stand.
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