1. The insurance companies get the federal government to mandate that everyone must purchase insurance. (Insurance companies 1, consumers 0)
2. There are only private insurance plans available. (Private Insurers 2, consumers 0)
3. The federal government gets states who feel like it to create an exchange to help consumers shop for -- and insurance companies sell -- their private insurance. (Private insurers 3, consumers 0) [And insurance companies get an extra point in states that don't like federal intrusion]
4. The federal government then subsidizes consumers to help them pay the full premiums charged by the private insurance plans. Insurers win! 4-0!
Bend over, here it comes again.