The Plank

Health Care To The Max: Baucus Plan Out (updated)

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As reported in this week's edition, Max Baucus and his staff at the Senate Finance Committee have been working on health care reform since the beginning of summer. Today, he will publish a preliminary outline of what he has in mind. Afterwards, he plans to resume discussions with Senator Ted Kennedy and his staff at the Health, Education, Labor, and Pensions Committee. They still hope to produce one joint bill, although--as Ezra Klein noted--tensions over committee turf may get in the way.

What will Baucus propose? It look a lot like the plan Barack Obama touted on the campaign trail: Expanded Medicaid and S-CHIP for the poor; a pooling mechanism that allows individuals and the uninsured to buy coverage at group rates; a new public insurance plan, modeled vaguely on Medicare, that would be available to people buying coverage through the new pool; subsidies to offset the cost of insurance coupled with efforts to restrain the cost of medicine in the long term; and regulations that force insurers to sell to everybody, regardless of pre-existing condition.

But Baucus' plan will differ from Obama's in one intriguing, and important, way. According to the Wall Street Journal's Laura Meckler, it will include a requirement that all people obtain insurance. In other words, it will include an individual mandate. That was a major source of contention during the Democratic primaries. Obama opposed such a mandate, while Senator Hillary Clinton supported it.  (As readers of this space know, I think Clinton was absolutely right about this.)

Speaking of Clinton, I didn't mention her in my article on health care reform this week, largely because she hasn't been a major player in the Senate discussions so far. But that's partly because she was preoccupied with presidential politics for so much of the year. And with the election over, we may start hearing more from her, according to a new story by Time's Karen Tumulty:

Already it appears that Clinton may use her own experience in the White
House to try to nudge Obama to keep his many promises. A
larger-than-expected deficit forced her husband to delay some of his
priorities in 1993, a decision that greatly upset Hillary Clinton and
her allies at the time. While there are already those who are arguing
that Obama's ambitious and expensive health-care-reform effort will
have to wait until the economy is in better shape, Clinton disagrees.
"I'm going to make the case that it's important to move simultaneously
on several fronts. I know how difficult that is. But a new President
has a honeymoon period," she said. "I hope that we're going to really
make progress on health care right off the bat with a new Congress.
There are a lot of different ways of doing that."

Exactly what role Clinton can play remains unclear, since she doesn't have the committee seniority to assert herself the way, say, Baucus or Kennedy does. But she remains one of the most visible and, on health care, one of the most trusted policymakers in Washington. If she wants to say something, she'll be heard. And that's a good thing.

Update: Anthony Wright of California's Health Access offers a smart take on the whole indivdiual mandate quesiton here

Update 2: Below is the conclusion to the executive summary, which I just received. Note the critical passages I've put in bold--the push to tackle health care reform next year and the frank acknowledgement that reform will pay for itself only over the long run.

I believe it is the duty of the next Congress to reform America’s health care system.  In 2009, Congress must take up and act on meaningful health reform legislation that achieves coverage for all Americans while also addressing the underlying problems in our health system.  The urgency of this task has become undeniable.

In the short term, health care reform would cost taxpayers more than the government can achieve in savings from all reforms and financing changes.  Congressional leaders and the public must be realistic about the timeframe in which the fiscal success of reform is measured.  If we fail to act, however, we will double our current national expenditure on health care from $2 trillion to $4 trillion, continue to witness the plight of tens of millions of our citizens without health insurance cost shifting to those who do, continue to tolerate poor quality that leads to nearly 100,000 deaths a year, and watch our businesses become less competitive and our nation go further into debt.  In short, we all must realize that the costs of inaction, both in human and financial terms, will eventually be far greater than any initial outlays.  We must choose to invest now in a health care system that will richly repay the nation with greater health and economic stability in the long term.

--Jonathan Cohn 

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