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No Choice?

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You know that saying, about how it’s better to be right than popular? Senator Ron Wyden does.

As it’s become increasingly clear that the Wyden’s Healthy Americans Act would not be the basis for reform, he has concentrated on promoting one of its central elements: Choice. All of the bills moving through committee would set up insurance exchanges, through which people could choose from among regulated, quality health plans. But only individuals buying insurance on their own and some small businesses could use the exchanges. People who had access to coverage through large employers would be stuck with whatever their employers chose, with no alternatives. (The exception would be people who qualified, based on income, for subsidies; they’d still be able to go through the exchanges.)

Wyden’s idea, which he calls the “Free Choice” proposal, is to let anybody buy insurance through the exchanges--and, crucially, to let these people take their employer contributions with them. In other words, if you worked for the All American Widget Company, you could choose from among the plans the Widget Company’s benefit department had selected--or you could decide to buy your own policy through the exchange. And if you opted for the exchange offerings, you could use the money the Widget Company would have given you to pay the cost of its plan.

Like the Healthy Americans Act, the Free Choice proposal is a solid idea on the merits, one that has won Wyden praise from experts and writers (including me). And, like the Healthy Americans Act, the Free Choice proposal has run into a buzz-saw of special interest opposition. Employers don’t like it, benefits managers don’t like it, unions don’t like it--in each case, because it means these groups have less control over, or stand to derive less loyalty from, workers over health care decision-making.

The groups are being incredibly short-sighted.

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