has a post up<\/a> on the exchanges, and\u00a0a concern\u00a0that the standardized tiers, fixed subsidy level, and open pricing will drive insurers to set their prices high, and drive consumers to purchase the higher-cost option as a marker for quality.\u00a0 Because the subsidy is fixed based on the 2nd-lowest-cost \u201csilver\u201d plan, insurers collectively benefit from that 2nd-lowest-silver-plan being expensively priced.\u00a0 <\/p>\nAnd that much is true \u2014 the entire system would benefit from insurers providing their pricing structure to the government without having any means of knowing where that subsidy baseline will fall, and there would indeed be some benefit to a level of discretion that means that the government may elect a lower subsidy level, to keep the insurers in line.\u00a0 But the insurance companies still have to compete with each other, and the problem here is a different one entirely.<\/p>\n
McArdle titles her post \u201cDo We Need Less Transparency on ObamaCare?\u201d \u2014 but the problem is that the very nature of the exchanges limits the transparency and the ability of the consumer to comparison shop.<\/p>\n
If I want to buy the latest Rick Riorden title (for my kids, of course), I can comparison-shop at Amazon, Barnes & Noble, or a discounter. If I want to buy some new clothes, online shopping isn\u2019t going to work \u2014 at least not for me, and, I think, not for women\u2019s clothes in general.\u00a0 Except for those rare product lines where the sizing is reliable and the quality is consistent, I need to look at the item myself.<\/p>\n
And in the same way, there\u2019s a lot missing from the exchanges:\u00a0 how is the company\u2019s customer service?\u00a0 How broad is the provider network, and, if it\u2019s limited, how good are they about keeping doctors in their network vs. constantly reshuffling them?\u00a0 How onerous are their preapproval processes?\u00a0 Do they have any innovations in coordination of care or evidence-based medicine?\u00a0 If it\u2019s a high-deductible plan, do they provide tools to help consumers find lower cost options for a given procedure?\u00a0 For that matter, do they actively work to prevent fraud? And how extensive is their\u00a0coverage of the\u00a0benefits in the fine print?\u00a0 (Many years ago, back when our insurance was generous, I learned how much this matters \u2014 our company covered speech therapy for any reason, with no copay, for our weekly visits with my son; my friend had to pay out of pocket for her son because it was considered \u201cdevelopmental\u201d and not covered under their policy.)<\/p>\n
I don\u2019t know about you, but last year at annual enrollment we were presented with multiple options which, on the face of it, seemed indistinguishable except that one was considerably more expensive than the other.\u00a0 (Remember, I\u2019m an actuary, but a consulting actuary \u2014 I don\u2019t work at an insurance company.)\u00a0\u00a0I suspected that the more expensive policy was probably better in all these intangibles\/fine print areas, but we had no way to assess that, or whether they just were unlucky enough to have an unhealthier pool of employees for some other reason.<\/p>\n
Now, I\u2019ve said before that I don\u2019t have a problem with subsidies, if they were structured more sensibly.\u00a0 But there\u2019s no reason it would need to be tied to a government-run insurance agency.\u00a0\u00a0If an old-fashioned insurance agent provide value by helping his customers understand which plans provide value for the money (while being open about commissions), or a competing website can develop metrics that allow consumers to comparison-shop more effectively, shouldn\u2019t they be able set up shop, with their customers still able to pick up the subsidy?<\/p>\n<\/body><\/html>\n","protected":false},"excerpt":{"rendered":"
Lunch break! Megan McArdle has a post up on the exchanges, and\u00a0a concern\u00a0that the standardized tiers, fixed subsidy level, and open pricing will drive insurers to set their prices high, and drive consumers to purchase the higher-cost option as a marker for quality.\u00a0 Because the subsidy is fixed based on the 2nd-lowest-cost \u201csilver\u201d plan, insurers […]<\/p>\n","protected":false},"author":2209,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-787","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"yoast_head":"\n
What is and isn't "transparent" in the O'Care Exchanges<\/title>\n<meta name=\"description\" content=\"Lunch break!Megan McArdle has a post up on the exchanges, and a concern that the standardized tiers, fixed subsidy level, and open pricing will\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.patheos.com\/blogs\/janetheactuary\/2013\/10\/what-is-and-isnt-transparent-in-the-ocare-exchanges.html\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"What is and isn't "transparent" in the O'Care Exchanges\" \/>\n<meta property=\"og:description\" content=\"Lunch break!Megan McArdle has a post up on the exchanges, and a concern that the standardized tiers, fixed subsidy level, and open pricing will\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.patheos.com\/blogs\/janetheactuary\/2013\/10\/what-is-and-isnt-transparent-in-the-ocare-exchanges.html\" \/>\n<meta property=\"og:site_name\" content=\"Jane the Actuary\" \/>\n<meta property=\"article:published_time\" content=\"2013-10-11T12:40:00+00:00\" \/>\n<meta name=\"author\" content=\"Jane the Actuary\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Jane the Actuary\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"3 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/www.patheos.com\/blogs\/janetheactuary\/2013\/10\/what-is-and-isnt-transparent-in-the-ocare-exchanges.html\",\"url\":\"https:\/\/www.patheos.com\/blogs\/janetheactuary\/2013\/10\/what-is-and-isnt-transparent-in-the-ocare-exchanges.html\",\"name\":\"What is and isn't \\\"transparent\\\" in the O'Care Exchanges\",\"isPartOf\":{\"@id\":\"https:\/\/www.patheos.com\/blogs\/janetheactuary\/#website\"},\"datePublished\":\"2013-10-11T12:40:00+00:00\",\"dateModified\":\"2013-10-11T12:40:00+00:00\",\"author\":{\"@id\":\"https:\/\/www.patheos.com\/blogs\/janetheactuary\/#\/schema\/person\/ed9b99e0bd58c5eeeebae6b82fa5a77a\"},\"description\":\"Lunch break!Megan McArdle has a post up on the exchanges, and a concern that the standardized tiers, fixed subsidy level, and open pricing will\",\"breadcrumb\":{\"@id\":\"https:\/\/www.patheos.com\/blogs\/janetheactuary\/2013\/10\/what-is-and-isnt-transparent-in-the-ocare-exchanges.html#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/www.patheos.com\/blogs\/janetheactuary\/2013\/10\/what-is-and-isnt-transparent-in-the-ocare-exchanges.html\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/www.patheos.com\/blogs\/janetheactuary\/2013\/10\/what-is-and-isnt-transparent-in-the-ocare-exchanges.html#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/www.patheos.com\/blogs\/janetheactuary\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"What is and isn’t “transparent” in the O’Care Exchanges\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/www.patheos.com\/blogs\/janetheactuary\/#website\",\"url\":\"https:\/\/www.patheos.com\/blogs\/janetheactuary\/\",\"name\":\"Jane the Actuary\",\"description\":\"\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/www.patheos.com\/blogs\/janetheactuary\/?s={search_term_string}\"},\"query-input\":\"required name=search_term_string\"}],\"inLanguage\":\"en-US\"},{\"@type\":\"Person\",\"@id\":\"https:\/\/www.patheos.com\/blogs\/janetheactuary\/#\/schema\/person\/ed9b99e0bd58c5eeeebae6b82fa5a77a\",\"name\":\"Jane the Actuary\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\/\/www.patheos.com\/blogs\/janetheactuary\/#\/schema\/person\/image\/\",\"url\":\"https:\/\/secure.gravatar.com\/avatar\/8d6a493d380e87d49599d5487691c9fc?s=96&d=mm&r=g\",\"contentUrl\":\"https:\/\/secure.gravatar.com\/avatar\/8d6a493d380e87d49599d5487691c9fc?s=96&d=mm&r=g\",\"caption\":\"Jane the Actuary\"},\"url\":\"https:\/\/www.patheos.com\/blogs\/janetheactuary\/author\/actuaryjane\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"What is and isn't \"transparent\" in the O'Care Exchanges","description":"Lunch break!Megan McArdle has a post up on the exchanges, and a concern that the standardized tiers, fixed subsidy level, and open pricing will","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/www.patheos.com\/blogs\/janetheactuary\/2013\/10\/what-is-and-isnt-transparent-in-the-ocare-exchanges.html","og_locale":"en_US","og_type":"article","og_title":"What is and isn't \"transparent\" in the O'Care Exchanges","og_description":"Lunch break!Megan McArdle has a post up on the exchanges, and a concern that the standardized tiers, fixed subsidy level, and open pricing will","og_url":"https:\/\/www.patheos.com\/blogs\/janetheactuary\/2013\/10\/what-is-and-isnt-transparent-in-the-ocare-exchanges.html","og_site_name":"Jane the Actuary","article_published_time":"2013-10-11T12:40:00+00:00","author":"Jane the Actuary","twitter_card":"summary_large_image","twitter_misc":{"Written by":"Jane the Actuary","Est. reading time":"3 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"https:\/\/www.patheos.com\/blogs\/janetheactuary\/2013\/10\/what-is-and-isnt-transparent-in-the-ocare-exchanges.html","url":"https:\/\/www.patheos.com\/blogs\/janetheactuary\/2013\/10\/what-is-and-isnt-transparent-in-the-ocare-exchanges.html","name":"What is and isn't \"transparent\" in the O'Care Exchanges","isPartOf":{"@id":"https:\/\/www.patheos.com\/blogs\/janetheactuary\/#website"},"datePublished":"2013-10-11T12:40:00+00:00","dateModified":"2013-10-11T12:40:00+00:00","author":{"@id":"https:\/\/www.patheos.com\/blogs\/janetheactuary\/#\/schema\/person\/ed9b99e0bd58c5eeeebae6b82fa5a77a"},"description":"Lunch break!Megan McArdle has a post up on the exchanges, and a concern that the standardized tiers, fixed subsidy level, and open pricing will","breadcrumb":{"@id":"https:\/\/www.patheos.com\/blogs\/janetheactuary\/2013\/10\/what-is-and-isnt-transparent-in-the-ocare-exchanges.html#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/www.patheos.com\/blogs\/janetheactuary\/2013\/10\/what-is-and-isnt-transparent-in-the-ocare-exchanges.html"]}]},{"@type":"BreadcrumbList","@id":"https:\/\/www.patheos.com\/blogs\/janetheactuary\/2013\/10\/what-is-and-isnt-transparent-in-the-ocare-exchanges.html#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/www.patheos.com\/blogs\/janetheactuary"},{"@type":"ListItem","position":2,"name":"What is and isn’t “transparent” in the O’Care Exchanges"}]},{"@type":"WebSite","@id":"https:\/\/www.patheos.com\/blogs\/janetheactuary\/#website","url":"https:\/\/www.patheos.com\/blogs\/janetheactuary\/","name":"Jane the Actuary","description":"","potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/www.patheos.com\/blogs\/janetheactuary\/?s={search_term_string}"},"query-input":"required name=search_term_string"}],"inLanguage":"en-US"},{"@type":"Person","@id":"https:\/\/www.patheos.com\/blogs\/janetheactuary\/#\/schema\/person\/ed9b99e0bd58c5eeeebae6b82fa5a77a","name":"Jane the Actuary","image":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/www.patheos.com\/blogs\/janetheactuary\/#\/schema\/person\/image\/","url":"https:\/\/secure.gravatar.com\/avatar\/8d6a493d380e87d49599d5487691c9fc?s=96&d=mm&r=g","contentUrl":"https:\/\/secure.gravatar.com\/avatar\/8d6a493d380e87d49599d5487691c9fc?s=96&d=mm&r=g","caption":"Jane the Actuary"},"url":"https:\/\/www.patheos.com\/blogs\/janetheactuary\/author\/actuaryjane"}]}},"_links":{"self":[{"href":"https:\/\/www.patheos.com\/blogs\/janetheactuary\/wp-json\/wp\/v2\/posts\/787","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.patheos.com\/blogs\/janetheactuary\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.patheos.com\/blogs\/janetheactuary\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.patheos.com\/blogs\/janetheactuary\/wp-json\/wp\/v2\/users\/2209"}],"replies":[{"embeddable":true,"href":"https:\/\/www.patheos.com\/blogs\/janetheactuary\/wp-json\/wp\/v2\/comments?post=787"}],"version-history":[{"count":0,"href":"https:\/\/www.patheos.com\/blogs\/janetheactuary\/wp-json\/wp\/v2\/posts\/787\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.patheos.com\/blogs\/janetheactuary\/wp-json\/wp\/v2\/media?parent=787"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.patheos.com\/blogs\/janetheactuary\/wp-json\/wp\/v2\/categories?post=787"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.patheos.com\/blogs\/janetheactuary\/wp-json\/wp\/v2\/tags?post=787"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}