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Ezra Klein: Insurance Exchanges Don’t Work and Must be Expanded Dramatically

I’ve often find  Ezra Klein’s writing about health care policy confusing because from blog post to blog post there is often a jarring disconnect that can best be described at policy schizophrenia. The issue is most pronounced in his alternating from defender of health insurance exchanges, mostly when defending Obama, and his acknowledging they have been a proven failure, mostly when criticizing Republicans.

Take for example these two posts literally days apart. Today, Klein called the Republican plan to save money by turning Medicare into a private insurance exchange voucher program, “a plan that has never worked,” with examples to prove his case.

What they’ve got in mind already exists in Medicare. “Our premium-support plan is modeled after the Medicare Part D prescription-drug program,” Paul Ryan (R-Wis.) told me. But Part D hasn’t controlled costs. Instead, premiums have risen by 57 percent since 2006, and the program is expected to see nearly 10 percent growth in annual costs over the next decade.

Moreover, this isn’t the first time we’ve tried to let private insurers into Medicare to work their magic. The Medicare Advantage program, which invited private insurers to offer managed-care options to Medicare beneficiaries, was expected to save money, but it ended up costing about 120 percent of what Medicare costs.

Klein has established not only that purely private health insurance exchanges fail to control cost but expand them into our public health programs has also proven to be a costly failure.

Yet, less than 24 hours earlier, while defending Obama, that Klein again argued in support of effectively eliminate Medicare and Medicaid by folding them into the state based insurance exchanges created by the Affordable Car Act.

The major difference is that the Affordable Care Act doesn’t roll Medicare and Medicaid into the exchanges, though that’s something that many of the law’s advocates — myself included — would eventually like to see happen.

So, Klein both believes health insurance exchanges are an idea that has “never worked” at controlling cost but also an idea that should be radically expanded.

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Jon Walker

Jon Walker

Jonathan Walker grew up in New Jersey. He graduated from Wesleyan University in 2006. He is an expert on politics, health care and drug policy. He is also the author of After Legalization and Cobalt Slave, and a Futurist writer at