Healthcare reform will create some semblance of a real insurance market

One of my favorite pieces of the healthcare reform bill was the creation of exchanges wherein private insurers could compete for customers. I wish they were more inclusive – and I hope that in the future these exchanges really will be inclusive of the entire health insurance market – but for now they’re a start. The exchanges – not the public option – are the fundamental strength of this healthcare bill, and for all its other flaws this may be its saving grace. With smart reforms in the future, the exchanges could make health insurance a more transparent, competitive and customer-friendly market which would be great for cost and quality. They could be severely limited, actually, by a public option which would skew the market away from healthy competition and toward price controls. Republicans would be wise to consider ways they can enact future reforms (rather than simply attempting to repeal the bill) that would make the health insurance market even more competitive and less dependent on state support.

Andrew agrees, and points to this post from the estimable Noah Millman:

My own inclination is to say that Obama’s health-care proposal is a step in the right direction, the kind of reform that would make it easier for a subsequent Republican administration to reform it in a direction that will be more open to the kinds of price signals that drive medical innovation and, in turn, actually lower costs. Such reforms are essentially impossible until a functional individual insurance market is created, and the Obama health-care plan, if it works, promises to create such a market. That’s a big “if” – but if it doesn’t create a functional individual insurance market, then it will fail, and the citizenry, rather than demanding repeal, will demand that it be changed to make that market work.

I’ve been reading through Noah’s policy platforms (here: one, two, three, four, five, and six) and they really are worth reading.  Number five touches on infrastructure and development, and this is one of those areas (like urban sprawl) which I think the right and the left should be able to come together on.

Indeed, this will be my project going forward. Not simply looking at ‘moderate’ policies and proposals, but seeking out issues which can be areas of common ground and common discussion. I think, for all our inherent differences, for all the cultural divides and economic inequities between us, Americans are still a group of people loosely united in a grand, human project. While our political leaders and punditocracy may attempt always to divide us, I think there really is room for a common discourse.

I want to emphasize that I am entirely uninterested in the ideas of “moderate” or “centrist” positions.  Common ground does not necessitate centrism or moderation.  Too often those seem like the easy way out, as though simply moving toward the center on every issue, toward some place of compromise, is the best way forward.  I would suggest that the middle can be as ineffectual and terrible a place as either wing. Rather, we should seek out common cause and explore our very differing beliefs and ideas on how that cause can best be achieved.  If this is a bit vague at the moment, I apologize.  More will be forthcoming.

On the issue of healthcare, there is no doubt that the need for reform is a moral and fiscal imperative.  This may not be the bill we were looking for, but it’s better than nothing. It’s not the bill I would have written, but 30 million Americans will have insurance that otherwise would not have had it, and a real marketplace will be created which can be reformed for the better down the road.