That was the thinking behind the Healthy Americans Act cosponsored in 2008 by Democratic Sen. Ron Wyden and then-Sen. Robert Bennett, a Republican. Bennett says it bothers him that Obamacare was built on the present system. “Trying to hang on to the present health care system that was based back in the 1950s is a really dumb idea,” he says. “Wyden was willing to conspire with me to create an entirely new system based on the way people live today.”

Their proposal, which had substantial bipartisan support, would have created state exchanges, required people to buy insurance, and instituted federal premium collections and subsidies to finance the system. The Congressional Budget Office estimated Wyden-Bennett would be “essentially self-financing” in its first year. Employers could continue to offer coverage, but the authors’ intent was that nearly every American under 65 would participate in the new system. Dean favored a different kind of break with the status quo: a public option on the exchange that would piggyback on the Medicare infrastructure and offer cheaper rates than private insurers. “My side mostly didn’t win,” he says, but he sees constructive possibilities under the new law. Exchanges are providing universal coverage in Switzerland, the Netherlands, and elsewhere, he says, so we know “it’s buildable. Now we just need to figure out how to make it work.”

Moving to an insurance exchange may be disruptive and upsetting. Yet most of those dumpees from Trader Joe’s may find they get a better deal on the exchanges, especially since the company is giving them $500 toward premiums, on top of government subsidies they may receive if their household incomes are low. The “compared to what” factor, as White House adviser David Simas calls it, should be even more dramatic for people in the individual market who currently can’t afford coverage, can’t get coverage because of their health, or can only get temporary and costly COBRA coverage.