The report also gives no credit to any of the reforms designed to reduce health care spending, from delivery reform to the new excise tax on high-end insurance policies. You can see this quite clearly in the charts at the end of the report. At the bottom, each one has a box that says "This does not include the insurer tax." Admittedly, most of these savings will take time to materialize and the study, as best as I can tell, is primarily concerned with the immediate future. Then again, the study doesn't appear to give any credit whatsoever to the economies of scale and management that exchanges are expected to bring.

That's not to say BCBSA's are baseless. The argument about a strong mandate, in particular, is one with which many experts (and this writer) agree. Absent a sufficiently strong requirement to buy insurance, premiums could certainly go up faster than they would otherwise, although 50 percent seems awfully high. In addition, Oliver Wyman says the study doesn't take account of medical inflation, which, presumably, would actually cut in the other direction--i.e., it would make the figures seem worse.

And, to the credit of Oliver Wyman, the underlying calculations look more sophisticated than what PriceWaterhouseCoopers did for AHIP. This is the result of actuarial modeling, based on a large data set provided by Blue Cross plans from across the country. That doesn't make it perfect; even the best models don't really predict the future. But Oliver Wyman's basic method is sound. Or so the people who follow such things tell me. If BCBSA had avoided hyperbole and made more honest assumptions, they could have produced a study that was genuinely useful, albeit one that possibly made the case for more aggressive reforms rather than less.

But you have to wonder whether BCBSA really wants to be useful. Over the last few months, administration and Capitol Hill sources have repeatedly described the Blue Cross plans as among the most outwardly hostile to reform, apparently because they have the most to lose. The most radical changes in health care reform will come in the highly dysfunctional markets for people buying coverage on their own and for small businesses--markets that state-based Blue Cross plans happen to dominate.