Sen. Max Baucus has introduced a health care reform that has generally been considered the bill most likely to become the basis for on-going negotiations. Crafted with a view towards winning the support of at least a handful of Republicans, the Baucus proposal is thought to have the best shot at winning the magic 60 votes in the U.S. Senate. Let’s hope this is not the case.
The general problem with the Baucus plan is summed up in Ceci Connolly’s piece in the Washington Post, albeit unintentionally. Connolly writes: "But behind the rhetorical fireworks was a sense that the fragile coalition of major industry leaders and interest groups central to refashioning the nation’s $2.5 trillion health-care system remains intact." Connolly suggests that this is why the bill has the best chance at passage. That is probably true: Connolly is a better reporter with better sources than me. But, Democrats are fools to go for this bill as written, and the kind of fools who will deserve to lose in next year’s midterm elections.
"Major industry leaders" and "interest groups" are not middle class voters. Yes, to reach those voters you need the financial means to do so, and industries and interest groups provide much if not most of the funds for incumbents’ re-election campaigns. In this off-year, members of Congress are spending a lot of time building up their war chests, a tiresome and degrading process of calling people to beg for money and attending boring fundraisers with unappetizing hors d’oeuvres and bad wine. The threat from an industry chieftain or a labor leader to not write a check is a threat designed to produce a visceral reaction in the member of Congress.
The Baucus plan suffers from two fatal flaws. First, the requirement that no one be denied coverage because of a pre-existing condition will not go into affect until 2013. Hello? Most middle class voters with health insurance are wary of change because they like the coverage they have. The one thing that consistently makes them most nervous about their coverage, or strikes against their sense of fairness, is the insurance industry’s practice of denying coverage for pre-existing conditions. Why would you delay the candy in reform for four years? The ban on denial of coverage should start while the ink is still wet on the final bill. The day after the President signs the final reform bill, the Department of Health and Human Services should send a letter telling every American that if they have been denied coverage for a pre-existing coverage, they should re-apply immediately and that if they are denied coverage again, they can call a toll-free number for the government to take action against the insurance company.
The second problem with the Baucus bill is that he has lowered the amount of the government subsidies to poor and middle class citizens for their purchase of health insurance. This will not affect the most poor, but a family of four that makes $66,000 a year might not appreciate having to shell out 10k for insurance. Like all the plans, they must buy insurance, but they make too much money for a subsidy or the subsidy will be very small. Unless the price of insurance comes down radically – and the Baucus plan does not have a public option to help force prices down – that family will not experience this reform as beneficial but as an imposition.
Both of these provisions lower the overall cost of the plan to $774 billion over ten years, compared to the $900 billion-plus House plans. But, I recall one of the first times I went to dinner with the owner of the restaurant where I worked for seventeen years. We were selecting the wine and there was a bottle of good, but not great, quality for $35 and a really superb bottle for $45. I described the two wines to him in precisely those terms and he ordered the $45 bottle, turned to me, and said, "Measure the difference." That is, if you are going to spend $35 anyway because you must have something to drink, why not spend the extra $10 and get the really good wine. Now, maybe you don’t have that extra $10 so the issue is moot. But, the point is – don’t get sticker shock by the higher price, if the quality is significantly better than the lower amount that you must pay anyway. Applied to the Baucus plan, $12.6 billion per year is not reason to anger much of the middle class.
Baucus, who was first elected to the Senate in 1978, has a reputation for bipartisanship which is not quite the same thing as having a reputation for moderation. He has a soft spot for protecting the corporate interests near and dear to the hearts of his Republican colleagues. And, like many who have been inside the Beltway for too long, his views of the outside world are skewed not just by interests groups, but by campaign professionals who are only too happy to convince any candidate that the issues do not matter as much as the pollster’s and advertising guy’s creativity. This layer of campaign professionals and consultants that exists between candidates and their constituents, turning elections into PR competitions, is the worst development in modern political life, it afflicts both parties, and I am clueless as to how to change it. But, if Democrats don’t wise up, vote for a bill based on what it does for middle class voters, and embrace the designation as the party responsible for health care reform, they will deserve to lose. And the campaign consultants won’t be able to help them.
The best way to get everyone the medical care they need at the price they can afford is to have everyone pay a reasonable amount of their income into a government fund which then pays the medical bills. There may be some other way to make it this simple; maybe by making insurance companies government contractors who manage the fund, but the Baucus plan is simply nonsense.
The Senators and Representative who are working on this should keep in mind that there is no escaping this one reality: special interests may pay politicians to vote their way, but if that vote offends enough individuals, there is no amount of money that can get that politician reelected. The public is wising up to the fact that negative campaigning is a sign of special interest money at work in elections.
You are right. The proposals thusfar are full of this kind of logical contradiction. Insurance provides financial protection. It does not provide medical protection even though it is called health insurance - just like car insurance does not prevent accidents, and homeowners insurance does not prevent household fires. If you have ever had any claims in these areas, you will see the similarities between how such claims are handled and how health insurance claims are handled. You are responsible for maintanance issues, while the coverage pays to fix the damage, but only up to the amount stated in your policy.
Insurance has its place, and would continue to have its place even in a world where everyone's medical expenses were paid by the government out of collectively funded account set up exclusively for that purpose. If that were to come to pass, there could still be a product called health insurance that people might choose to buy to cover expenses other than medical expenses incurred should they develop cancer or some other ailment that not everyone gets but that everyone fears could bankrupt them.
It is an unfortunate situation that what should have been a focus on health care reform has become an exercise in trying to redesign the principles that govern how insurance works.