Senate Finance chairman Max Baucus has labored long, hard - and in secret - to produce an 18 page summary of what Ezra Klein refers to as a “Not that bad health care bill.” The fact that I agree with Klein shouldn’t worry you. The irony is that he sees fault where I see merit and vice versa.
That should make both liberals and conservative heads explode.
In truth, there are reforms being proposed by Baucus that would do some real good as far as reducing health care costs, getting people who don’t have insurance now covered, and some long overdue Medicare reforms that would improve the quality of care.
There are also health insurance co-ops that will be so complex to set up, the chances of failure are great; expanded Medicaid coverage that will cost too much; and fees on insurance companies that don’t make any sense.
As far as mandates, no employer requirement to offer insurance but a “fee” will be assessed if an employee gets his own coverage equal to the premium and the subsidy offered by government. An individual mandate would be triggered in 2013 - everyone must have insurance either individually or through your employer.
I oppose mandates of any kind based on the notion that it is a violation of one’s individual liberty to have the government force anyone to part with their property (money) without their consent to be given to another entity or government itself. Even - or especially - if it is argued that such mandates are for the “good of all,” a government that can order you to buy insurance against your will can, and probably will, make other mischief as well.
Be that as it may, there is a serious attempt in the Baucus outline to address some fundamental problems with the health care industry. And although it doesn’t go near far enough in attempting to get a handle on Medicare costs, nor does it offer many solutions on the supply side of the health care equation, I consider it a good starting point for discussions on reform.
Ezra Klein mentions what he likes about the proposal:
The legislation really would protect millions of Americans from medical bankruptcy. It really would insure tens of millions of people. It really will curb the worst practices of the private insurance industry. It really will expand Medicaid and transform it from a mish-mash of state regulation into a dependable benefit. It really will lay down out-of-pocket caps which are a lot better than anything people have today. It really will help primary care providers, and it really will make hospitals more transparent, and it really will be a step towards paying for quality rather than volume.
Good summary of what’s good about the bill. I would quibble that the Medicaid expansion into a “dependable benefit” is a dubious idea, but Klein sums up most of what’s acceptable in a reform bill - something that those Republicans so inclined may wish to seriously examine.
But back to the irony part of our piece, here’s Klein on what’s wrong with it from his liberal perspective - most of these “problems” being something to cheer about if you’re a conservative:
The main disappointment is that insofar as you see the bill as a vehicle for moving us towards a better, more efficient, less costly system, there are some problems. In particular, this bill seems to block off a lot of its own possible points of expansion. The health insurance exchanges are limited to the state level, and appear to split the individual and small-group markets apart from each other. There’s no mention of a possible expansion toward larger employers, either. Similarly, the co-op plan is an interesting policy proposal, but unlike a public insurance option, it’s difficult to imagine it growing into anything significantly stronger than what’s outlined in the paper.
A government program with a built in brake on expansion? Be still my heart! That’s just what the doctor ordered. The two tiered employer market is also a good idea considering that for very small businesses, tax subsidies to help them cover full time employees should be generous while larger companies will obviously pay more.
I agree with Ezra that the co-op idea will probably not be as successful as Baucus would hope. This would be a massive undertaking - as big a job as setting up a public option. In the end, I don’t think enough people will participate in all 50 co-ops to give the program enough cash to do things like cover those with pre-existing conditions or who are denied coverage for other reasons. In short, an eventual government take over of the whole co-op system and what amounts to a single payer government run boondoggle would emerge. (For me, this is a deal breaker - a “no go” if it is included).
But there are bound to be things in any reform package that different people will find objectionable. There are a couple of proposals that are especially noteworthy and should be included in any reform measure.
1. Subsidies for those who earn up to 300% rather than 400% of the poverty line. This is fairer to the taxpayer. No one would have to pay more than 10% of their income out of pocket for health insurance.
2.Starting in 2015, states may form “health care choice compacts” that will allow companies to sell insurance across state lines.
3. The aptly described “young invincible” policy:
A separate “young invincible” policy would be available in addition to these benefit options. This policy would be targeted to young adults who desire a less expensive catastrophic coverage plan but with a requirement that preventive services be covered below the catastrophic amount. Cost-sharing for preventive benefits would be allowed.
Last night on my radio show, Rich Baehr, American Thinker Political Correspondent and a health insurance consultant for 25 years, wondered why the “young invincible” policy would be limited to those 25 years old and younger. Why not offer it to everyone, Rich asked?
The point is this; using the analogy of auto insurance, no company covers oil changes, pressurizing tires, or other routine services. This is one way premiums are kept down. And if only major medical problems would be covered, people would be less apt to incur health care costs for minor, non life threatening treatments.
Baehr uses his own analogy involving shoes. If government were to pay for shoes, everyone would have a closet full. Forcing almost everyone to buy “comprehensive” insurance only encourages people to load up on shoes even though they don’t need them.
4. Physician and hospital “value based” purchasing. The proposal would reward hospitals for the quality of their care for high cost services and reward doctors for not ordering unnecessary tests in some cases.
This is a step in the right direction although it doesn’t go far enough. We must change the supply culture in health care so that quality of care is paramount and quantity is discouraged.
5.Incentives to develop new patient care models. Always a good idea to incentivize innovation.
6. Payment penalty for hospital acquired infections. More of this please. Rewarding quality and penalizing poor care should be at the heart of reform.
7. Modest reforms in the Medicare Advantage (supplemental insurance) plans rather than severely curtailing the plans as the House bill would do.
8. There isn’t much to get excited about in the Medicare reform sections except the formation of a full time Medicare Commission to examine ways to reduce costs. Otherwise, there is too much emphasis on costs and not enough on the supply side of the equation.
9. A tax on gold plated plans costing more than $8,000 per year for singles and $21,000 per family. These plans are a waste that we can do without. If you can afford that kind of insurance, you can afford greater out of pocket medical care.
In summary, there is a lot to dislike in the bill. Medicaid expansion will put even more budgetary pressures on states already suffering - even with additional federal funds that would only add to the deficit. The co-op idea is a loser, the Medicare reforms only nibble around the edges of the problem (we must save trillions over the next few decades), the employer requirements are still too onerous for small businesses, and the individual mandate is an affront to liberty.
But for those conservatives serious about reforming our health care industry - and I believe good conservatives should be - then there are some things in the Baucus plan that should be given serious consideration.
10:25 am
I agree with your assessment that the Baucus plan has a lot of good points that deserve attention and should be examined. That said, the devil will be in the details.
For example: “4. Physician and hospital “value based” purchasing. The proposal would reward hospitals for the quality of their care for high cost services and reward doctors for not ordering unnecessary tests in some cases.”
Who will determine what are “unnecessary tests”? Despite biology and chemistry being a science, medicine is a merger of science and art. What works for one person doesn’t work for another and therefore an unncessary test for one person, is a necessary step for another to diagnose.
These “unnecessary steps savings” concept will not fly especially since the plan doesn’t address tort reform. Any savings/rewards for doctors may not offset the loss in the “sue the pants off them and make me instantly rich” mentality that exists today.
At the end of the day, I guess my bias will always be that a bill that doesn’t address tort reform will fail to bring down the costs which is the Administration’s reason for spending all this time, attention and money.
11:08 am
Hector said:
Excellent point. I’ve had THREE cases where my private insurance company tried to deny coverage of tests that they deemed unnecessary. Three very long and painful battles ensued between my private insurance company and me. My doctor worked with me as hard as she could and we eventually got them to concede, but it was a nightmare filled with insurance company bullshit and weak, uninformed (medically) logic on their part.
Bah. Nonsense. That idea is mostly a myth, and private insurance corporations do this already. Tort reform is a corporatist distraction from the boots on the ground reality. Tort reform limits rights and personal freedom, and is used as a red herring. A vast majority of “sue the pants off them” cases are tossed before they ever go anywhere, but only AFTER they gain headline attention. The sensationalist cases that get headlines distract from real people with actual cases of negligence and shoddy practice both by medial professionals and the insurance corporations.
2:58 pm
Here’s a detail: Whatever happened to that Republican written provision that whatever the Congress passed for us “little guys” had to apply to them as well? Voted right down, it was! Kind of like the voters are planning to do with their current representatives, for the most part. I’m represented by Rob Wittman - he’s a keeper!
I don’t believe that any doggone thing that Bozo in the White House might be willing to sign into law is anything that I can live with - with the emphasis being on the living part! I’m 67 years old - on the chopping block by his lights!
2:59 pm
I would remind everyone - and our president - that he is not our ruler, he is our EMPLOYEE and as such, he’s to do what WE think is best for us, not what HE thinks is best for us. It’s a simple concept, why cannot a man who claims to be a professor of constitutional law (cannot be proven like a lot of his bull) understand this? Hubris perhaps? Gadzooks, he’s a fraud.
9:16 pm
@Gayle Miller:
“I would remind everyone - and our president - that he is not our ruler, he is our EMPLOYEE and as such, he’s to do what WE think is best for us, not what HE thinks is best for us.”
That’s right. He has to do what WE think is best, not what YOU think is best.
The majority of Americans support a public option:
http://digitaljournal.com/article/278585
http://www.fivethirtyeight.com/2009/09/analysis-public-option-is-likely.html
http://washingtonindependent.com/48140/gop-poll-yes-people-want-a-public-option
http://www.upi.com/Top_News/2009/08/26/AARP-poll-shows-divide-over-public-option/UPI-42171251305003/
So you want the President to do what we the people want, right? No? Then that’s just fluff to make your bitter hatred sound patriotic, which is shameful.
8:41 am
Logic and reason? How unpatriotic of you busboy. It’s obvious that you hate America and are, by default, a socialist.
10:35 am
“…why cannot a man who claims to be a professor of constitutional law (cannot be proven like a lot of his bull) understand this? Hubris perhaps? Gadzooks, he’s a fraud.
Amazing how effective your reality distortion field is. Can you mass produce and market this? As long as you can adjust for the desired reality, I’d love to have one of these. Actually, I think both fringes seem to have a fair supply of such devices.
As for this one little bit of “reality”, don’t know why I bother but:
http://www.factcheck.org/askfactcheck/was_barack_obama_really_a_constitutional_law.html
UC Law School statement: The Law School has received many media requests about Barack Obama, especially about his status as “Senior Lecturer.” From 1992 until his election to the U.S. Senate in 2004, Barack Obama served as a professor in the Law School. He was a Lecturer from 1992 to 1996. He was a Senior Lecturer from 1996 to 2004, during which time he taught three courses per year. Senior Lecturers are considered to be members of the Law School faculty and are regarded as professors, although not full-time or tenure-track. The title of Senior Lecturer is distinct from the title of Lecturer, which signifies adjunct status. Like Obama, each of the Law School’s Senior Lecturers have high-demand careers in politics or public service, which prevent full-time teaching. Several times during his 12 years as a professor in the Law School, Obama was invited to join the faculty in a full-time tenure-track position, but he declined.
Of course, I’m sure you want some kind of “non-existent” “official” document to prove something or other. . . he’s not human, we don’t have a copy of his genome by an approved right wing genetic lab. He wasn’t born on earth, no one alive has come forward as a witness.
Whatever, Gayle, enjoy your socialist medicare and hope the government keeps it’s hands off.
10:53 am
[...] WIDE AWAKES WIZBANG WUZZADEM ZERO POINT BLOG THE GREAT COMMUNICATOR OR THE GREAT PREVARICATOR? BAUCUS REFORM PLAN HAS SOME MERIT THE RICK MORAN SHOW: DON’T BOGART THAT JOINT SESSION MY PROBLEM WITH ‘FALSE’ [...]
12:21 am
Even if Baucus gets Democtratic support for his “bill” by the time it
gets out of the Senate there will be numerous changes (few for the better
in my opinion). And, once it gets out of conference, it may be almost unrecognizable. Want to bet it includes the $10 billion for the UAW that’s in HR3200? Bet that is not on his summary? Want to bet there is nothing substantial towards tort reform?
In any case, once you tell the insurance companies who they have to cover (everyone, including pre-existing conditions), what conditions they have to cover, that they can not put any limits on the total amount spent by them during the year or your lifetime for your care, and charge them a fee if they make too much profit, it seems to me that practically everything they do will be controlled by the Federal Government.
Write a plan based on conservative principles and ideas. Let everyone know you have a plan and what’s in it. Oppose the Democrats’ plans. When and if they pass it publicize the flaws and hope citizens will realize what a pig in a poke they have bought. Otherwise, their bill will just continue down that “slippery slope” towards total control of the health care market. And, in my view, substantially accelerate it.