OBAMA'S PLAN: CONCLUSIONS. Alright, finally tracked down the Health Insurance Exchange Markets piece of the puzzle. Obama's plan does force a type of community rating on all insurers -- they can't discriminate based on preexisting conditions, but can discriminate based on age. The markets are less of a regulatory agency and more of a purchasing collective: Think of them as a large company's HR department. Deductibility will still work the same way screwed up way, with employers getting to use pre-tax dollars and individuals and those going through the Exchange Market using post-tax dollars (and thus paying more for the same goods). Subsidies will be what attract individuals to the new markets, and thus what encourages insurers to participate. But they don't have to participate if they don't want to. What you're basically seeing here is that the Obama campaign believes affordability and ease of access (where do you buy insurance?) problems account for most of the uninsured. If they can fix those issues, they don't need a mandate. If this proves incorrect, they believe they can implement a mandate, or some other coverage-enhancing policies, down the road. In the end, Obama's plan sections off the health care market. Rather than going towards massive integration, in the way Wyden's plan does by channeling all health insurance through a single agency in each state, or the way Edwards' plan does by creating a Medicare option and then making it advantageous for folks to switch over from private insurance, Obama's plan seeks to correct the places in the market where we see folks having the most trouble getting insured. It builds on the current system much more than it transforms it. --Ezra Klein
