Originally Posted by Pawnmower
In my understanding the exchanges are just going to be a market where PRIVATE companies products (their health care line etc) can be compared and shopped for by consumers.
The exchange is just a way for private citizens to join together to get group rates, which are cheaper than a lone person.
The 'efficiency' is going to be the private companies issue, and I have faith in private companies that they will compete and find ways to succeed.
One of the biggest problems I have with the exchange system is that government is going to define the minimum acceptable coverage. That's a recipe for constant expansion/inclusion of non-basic, but politically popular coverages (e.g. contraception).
Going back to the concept of free riders in our current system, the basic coverage should just mimic what the uninsured are already afforded. That is, emergency and catastrophic care. Congress and governmental bureaucrats are not competent to decide what types of preventative care and elective care are cost effective. Instead, decisions will be based on politics, with those willing to give the most to those who don't have to pay for it always having the upper hand.