And so scientific exchanges, medical exchanges, working together on development issues -- all of that becomes very important.

WHITEHOUSE: The White House

Dr. Jay Himmelstein, chief health policy strategist at the Center for Health Policy and Research at the University of Massachusetts Medical School, has analyzed various models for implementing insurance exchanges, writing with a colleague in the journal Health Affairs linked here about the importance of following the lead of early adopters, particularly paying attention to technology.

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Mr. Starr, who broadly supports the Obama administration's efforts to overhaul the health system, has suggested that Democrats consider a system in which anyone who doesn't get insured can sign away access to the law's subsidies, insurance exchanges for buying policies and guaranteed coverage of pre-existing medical conditions for five years, rather than pay the fee.

WSJ: Insurers Make Plans in Case Health Mandate Is Quashed

Plans doing business on the exchanges must spend at least 80 percent of their premium dollars on medical care so they have to more closely watch their costs than perhaps ever before.

FORBES: Obamacare May Push Blue Cross Health Plans To Merge

No matter whether online shopping markets for millions of uninsured Americans to buy medical benefits are run by states or the federal government, these health insurance exchanges should effectively provide health benefits, say health insurers and others involved in running these entities.

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