Morning Must-Read: Aaron Carroll: Look, exchanges are either evil, or they’re not

Aaron Carroll: 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…. 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…. 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….

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 know that exchanges are, to some conservatives… preferable… [to] the single-payer-like Medicare system we have… that these same exchanges are less preferable… 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.