I've been following the health care debate pretty closely, and the proposal for health care exchanges seems to be a cornerstone for individual choice. But it's really just rearranging the chairs on the Titanic.
Consider the following hypothetical situation: a very healthy single 25-year-old man working a minimum-wage job goes to an exchange. Now, after rent and groceries and phone service, he doesn't have a lot of extra money floating around. The only plan he can afford from the "wealth of choices available" is a $50/month premium with a 10K deductible. He gets it. 6 months later, in spite of a flu shot, he gets the flu which turns into pneumonia. He spends weeks in the hospital. He loses his job. His health bills total $20,000. But he has a 10K deductible. And he doesn't have $10K in a savings account. And he's unemployed because the company he worked for doesn't have anything like sick days off. The fact that he had a "choice" of health plans is irrelevant.
Or take another case: somebody has bought a cadillac plan from an exchange, paid premiums for 5 years, then loses her job. Unemployment benefits run out. She has a choice: pay the rent, buy groceries, pay for utilities or pay for health care premiums. She's healthy so she drops the health care. Then she gets really sick. And she can't get help except from an emergency room because she no longer has health insurance.
The central problem with health care exchanges and this so-called health care reform is that everything depends on a person's being able to buy health insurance, pay the monthly premiums and cover the deductible. It is a system designed to save the private health insurance industry not to guarantee health care for all Americans.
No citizen of any other industrialized country has to depend on being employed, and earning enough to buy health insurance, to get health care. Only in the U.S., even under the proposed plans, is health care still to be a privilege not a right.