The important thing to understand is that this excise tax only applies to health insurance plans that are way too expensive. You call them “high-quality” plans, but it’s not clear that these plans actually provide better care. They are “high-cost” plans, and the people who receive them are the health care rich. These plans should be taxed to raise money to provide health care to people who can’t afford it.

If, as a result of this excise tax, the employers who offer these super-expensive plans decide to offer their workers cheaper plans instead, that’s a big step in the right direction isn’t it? Or are you arguing that union workers cannot afford or accept the very health-care plans the rest of us consider adequate?

Individuals are willing to pay huge amounts of money out of pocket for medical treatment, and the massive bureaucracies surrounding insurers and providers will not disappear. Providers want to squeeze every cent they can out of private insurers, and private insurers would rather pay a bureaucrat to contest a bill than simply pay the bill.

All the general-inflation-indexed excise tax will do is gut employer-provided plans (which tend for complex reasons to overwhelmingly affect unionized workers). Once a company has decided to provide high-deductible, high-copay insurance, why would removing the excise tax cause that company to reverse course and provide what it removed? The negotiated health plans will be gone, and unions are weaker today than they’ve ever been. It seems plausible to me that there would be no recovery of the lost high-quality health insurance plans.

Moreover, the excise tax is POPULAR with deficit-hawk centrists and conservatives. They *like* the excise tax, and not because it is supposed to control medical inflation, but because it makes the bill more “budget neutral.” Why wouldn’t they filibuster any attempt to remove it, or make removing it conditional on gutting other positive aspects of HCR.

I think Jon Walker at FDL is correct: During the conference committee, the White House should push to eliminate the excise tax — using the House’s deficit-reduction scheme instead — or index the tax to medical inflation, so it really only punishes those plans that are “excessive” relative to the industry mean.

The problem to be solved is medical inflation. This version of the excise tax doesn’t solve the problem except — as far as I can tell — by arguably irreversibly reducing the quality of existing health care over the long term.