One of the overlooked aspects of health care reform is the proposal for a national health insurance exchange, where small businesses and individuals could choose from a broader selection of plans than is normally available in their states. Conservatives, especially those with libertarian leanings, are always talking about how much they love market competition and consumer choice. So they should be all over this proposal for a national health insurance market? Right?
Nope. In fact, their response mostly has been one of silence. In a search through the Web sites for National Review and The Weekly Standard—easily the two most influential conservative magazines—the exchanges were mentioned only in connection with worries that illegal immigrants would be able to participate in them. Of course, most conservative criticism has understandably harped on the projected $1 trillion cost and $400 billion in new taxes associated with health care reform. But one wishes conservatives would stop their sky-is-falling mantras long enough to admit there might be a few things in health care reform that they don’t find totally repugnant.
So far, however, only The Heritage Foundation seems to be taking this idea of health insurance exchanges seriously. This Heritage policy expert is correct in warning that the combination of a national insurance exchange and a heavily subsidized public option could be a scheme to drive out private insurance. But, until the details of how this exchange would work are hashed out, it is easy to imagine other scenarios as does this Washington Post writer and this study by the Urban Institute.