Look, exchanges are either evil, or they’re not.

From the Fiscal Year 2015 House Budget Resolution:

Starting in 2024, seniors (those who first become eligible by turning 65 on or after January 1, 2024) would be given a choice of private plans competing alongside the traditional fee-for-service Medicare program on a newly created Medicare Exchange. Medicare would provide a premium-support payment either to pay for or offset the premium of the plan chosen by the senior, depending on the plan’s cost. For those who were 55 or older in 2013, they would remain in the traditional Medicare system.

The Medicare recipient of the future would choose, from a list of guaranteed-coverage options, a health plan that best suits his or her needs. This is not a voucher program. A Medicare premium-support
payment would be paid, by Medicare, directly to the plan or the fee-for-service program to subsidize its cost. The program would operate in a manner similar to that of the Medicare prescription-drug benefit.
The Medicare premium-support payment would be adjusted so that the sick would receive higher payments if their conditions worsened; lower-income seniors would receive additional assistance to help
cover out-of-pocket costs; and wealthier seniors would assume responsibility for a greater share of their premiums.

This approach to strengthening the Medicare program——which is based on a long history of bipartisan reform plans——would ensure security and affordability for seniors now and into the future. In September 2013, the Congressional Budget Office analyzed illustrative options of a premium support system. They found that a program in which the premium-support payment was based on the average bid of participating plans would result in savings for affected beneficiaries as well as the federal government.

Moreover, it would set up a carefully monitored exchange for Medicare plans. Health plans that chose to participate in the Medicare Exchange would agree to offer insurance to all Medicare beneficiaries, to avoid cherry-picking, and to ensure that Medicare’s sickest and highest-cost beneficiaries receive coverage.

If I took this language, swapped in “Americans” for “seniors” and “ACA” for “Medicare”, this would almost be a perfect description of the state exchanges that are part of the Obamacare.

I’m not naive. I know that exchanges are, to some conservatives, more preferable than the single-payer-like Medicare system we have now. I also know that these same exchanges are less preferable to many of them than the status quo ante. What I don’t understand, however, are people who declare community-rated, guaranteed-issue exchanges some unholy end-of-days totalitarian plan to destroy freedom when they’re part of the ACA, yet completely awesome and budget-saving when they’re part of Medicare.

My annoyance applies to people who do the opposite as well, by the way.


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