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Tilting at Windmills

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November 12, 2008

THE BAUCUS PLAN.... It's just a first step, and there are all kinds of political and policy details yet to come, but Senate Finance Committee Chairman Max Baucus' (D-Mont.) healthcare blueprint, unveiled today, is a very big deal. It's not entirely in line with the specifics of the Obama plan, as outlined during the campaign, but Baucus intends to push a policy that would guarantee health insurance for all Americans, expand expanding Medicaid and Medicare, and apparently include a healthcare mandate on individuals, with subsidies for those who can't afford insurance.

"Every American has a right to affordable, high-quality health care," Mr. Baucus said. "Americans cannot wait any longer." Far from being a distraction from efforts to revive the economy, he said, "health reform is an essential part of restoring America's economy and maintaining our competitiveness."

Mr. Baucus would create a nationwide marketplace, a "health insurance exchange," where people could compare and buy insurance policies. The options would include private insurance policies and a new public plan similar to Medicare. Insurers could no longer deny coverage to people who had been sick. Congress would also limit insurers' ability to charge higher premiums because of a person's age or prior illness.

People would have a duty to obtain coverage when affordable options were available to all through employers or through the insurance exchange. This obligation "would be enforced, possibly through the tax system," the plan says.

Paul Krugman noted, "[T]his looks very good for the reformers. There's now a reasonable chance that universal health care will be enacted next year!" Families USA executive director Ronald Pollack added, "The prospects for meaningful health care reform have never looked better."

Jonathan Cohn compares and contrasts Baucus' proposal with Obama's; Ezra Klein suggests the plan "looks like Obama Plus" (with an individual mandate, without a public insurer); Blue Girl takes a look at some of the political considerations of the upcoming debate; and Igor Volsky gets into "the guts" of the Baucus plan, including how he'd pay for it.

Baucus' blueprint is also online here.

Steve Benen 12:40 PM Permalink | Trackbacks | Comments (37)

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mandates suck. we went through this in the primaries and i still think they suck. i hope they get tossed as part of a compromise.

Posted by: TGP on November 12, 2008 at 12:52 PM | PERMALINK

Obama promised NO mandates on purchasing health insurance. That was perhaps the main reason I supported him over Hillary in the primaries. Will this be the first campaign promise he reneges on?

Mandated purchasing of health insurance is a horrible idea substantively and policy wise. It inevitably increases costs, decreases quality, limits personal choice and entrenches insurance company interests. I thought we just had an election against corporate socialism?

the lowest monthly cost for the not so successful MA plan is almost $700 a month.

Posted by: Beauregard on November 12, 2008 at 12:56 PM | PERMALINK

Haven't had a chance to look at the details of the plan, but this sounds like the right direction. I never understood why Obama was opposed to mandating coverage, it seems so clear that the system can't work unless everybody plays.

That said, I have to note that figuring out who can "afford" insurance and what the mechanism for adminstering the subsidies is bound to be a nightmare. Having just retired from a 20 year career in adminstering means tested programs, I can assure you that both calibrating the eligibilty criteria and monitoring compliance are never-ending and basically impossible tasks. Much better to use the system we already have in place for measuring people's relatively level of affluence, i.e., the tax system, and directly fund the system. Otherwise, the means testing issue is going to be a constant impediment to universal participation

Posted by: dcsusie on November 12, 2008 at 1:00 PM | PERMALINK

I think I missed the part that said Obama now embraces mandates. Let's see if there's a target before we start shooting, ok?

Posted by: tomeck on November 12, 2008 at 1:01 PM | PERMALINK

So which country's working system does this most nearly resemble? Germany's?

And Beauregard, you need to read more about health insurance economics. The two stupidest things Obama has favored are corn-derived biofuels, and a "non-mandatory" "universal" health insurance. If it's not mandatory, it doesn't work. Look at all the cheaper, better, systems in the rest of the world (there's about 20 of them) -- they're all truly universal, no opt-out.

Posted by: dr2chase on November 12, 2008 at 1:10 PM | PERMALINK

We mandate car insurance, home owners, flood insurance here in Houston, why not health insurance for the same reasons. To protect other people from having to pay the high costs of you thinking you won't need insurance.

Posted by: ScottW on November 12, 2008 at 1:16 PM | PERMALINK

mandates suck. we went through this in the primaries and i still think they suck. i hope they get tossed as part of a compromise.

I agree, but look at this: Insurers could no longer deny coverage to people who had been sick.

There's no way insurers would stand for that, so that'll be the opening for the Dems to shrug and say, well, we tried the private sector and they wouldn't play, so we'll just have to go with government health insurance.

At least, I hope so.

Posted by: Gregory on November 12, 2008 at 1:27 PM | PERMALINK

We mandate car insurance, home owners, flood insurance here in Houston, why not health insurance for the same reasons. To protect other people from having to pay the high costs of you thinking you won't need insurance. Posted by: ScottW

Excellent point. However, a lot of the people who can't afford health insurance also don't own cars and/or homes. I realize a lot people make choices amongst the three right now, but we need to make subsidized health care coverage available to everyone who needs it. Period.

Posted by: Jeff II on November 12, 2008 at 1:29 PM | PERMALINK

dr2chase, perhaps you should look closer at those international programs. none of them mandate purchasing health insurance from for profit deregulated corporations. they are generally single payer government based (which i have no problem with).

with a mandated system there is no incentive to reduce costs (to the consumer) because there is an enforced monopoly. the only incentive will be to push costlier insurees onto other plans so profits can be maximized better. this will inevtiably increase overall costs (to the consumer). then there's the issue of calculating and appropriating the "subsidies". it's all horribly inefficient and relies on assumptions that are extremely optimistic at best.

Posted by: Beauregard on November 12, 2008 at 1:31 PM | PERMALINK

As a professional medical person, I would have to conclude that the socialism has come home to roost for the Democratic Party. I see it every day in my dealings with the general public--they believe they are entitled to medical care, whereas we have a system that is based on access to health care on a striated level of ability to pay. This is capitalism.


Status quo=capitalism.

America=bankrupt and reeling and consumed with food riots and long lines to see a doctor in six to nine months.

I never thought that I would live to see the day when the General Secretary of the Chinese Communist Party's ideas would win out over the ideas of the man who dropped bombs on the minions of said General Secretary and blew them into fine powder and paste. America went with the commie over the patriot? What gives? Where was I when this was decided? Did I fall asleep and wake up on the day when it was decided that it was kosher to hate America?

I did not vote for that. I did not vote for food riots. I did not vote for vans filled with thugs with guns, shooting down the sick and the hungry. I did not vote for floating prisons on our nation's waterways. I did not vote for turning the state of North Dakota into a sprawling maximum security Federal Prison, complete with rabbit-proof fence and 100 foot wide moats filled with acid.

I voted for America, and all I got was this lousy communist takeover scheme.

Posted by: Professor Dingleberry on November 12, 2008 at 1:36 PM | PERMALINK

I'm completely in favor of universal health care but this seems like piling complexity onto an already dysfunctional system. Will health insurance companies' profit margins be controlled as well? It seems to me that Congress has always had a way-too-cozy relationship with our elected representatives. By the time they get through massaging this plan we'll wind up with an overpriced boondoggle that will put the military-industrial complex to shame.

Posted by: Dennis - SGMM on November 12, 2008 at 1:41 PM | PERMALINK

Thanks for the link-love Steve!

Posted by: Blue Girl on November 12, 2008 at 1:41 PM | PERMALINK

man, dingleberry. that was a helluva leap. get back on your meds.

anyway, the reason mandates are necessary is that without them, people who are younger and more healthy will opt out. without the contribution of everyone, it ends up making the coverage too expensive for those who cannot choose to opt out. everybody needs to share the cost.

Posted by: just bill on November 12, 2008 at 1:44 PM | PERMALINK

It seems to me that Congress has always had a way-too-cozy relationship with our elected representatives.
What I meant to write was It seems to me that BIg Pharma and Big Healthcare have always had a way-too-cozy relationship with our elected representatives.

(Asserted my Constitutional Right as a combat veteran to get drunk on November 11th. Just getting reacquainted with my senses.)

Posted by: Dennis-SGMM on November 12, 2008 at 1:50 PM | PERMALINK

Steve is treating this as good news, but I'm not sure why we should consider it to be a positive development when one of the most powerful, corrupt, and illiberal Senate Democrats publicly proposes a health care plan at direct odds with the plan of the incoming Democratic President, who was elected with a substantial mandate barely a week ago.

The conspicuous absence of a public provider, or an expansion of the federal employee health benefits program to cover anyone who wants it, tells you exactly where Baucus's bread is buttered. This is a plan to use tax dollars to mandate and purchase new patients for private health care providers. It's the Medicare Drug Benefit all over again.

This is better news than "Max Baucus opposes universal health care and pledges to grind Obama's plan down to sawdust in committee", but it isn't good news. This points to a full year of Congressional Democrats backstabbing, power-jockeying, and dick-swinging instead of getting things done.

Your best bet, if you support meaningful health care reform, is to support the "Rahm Emanuel leaves a horse head in Max Baucus's bed" plan. Elections have consequences. This issue was settled in the primary. For better or worse, Obama was elected on a specific promise not to impose an individual mandate. No good will come of trying to strong-arm him into caving in on this point.

Posted by: AJL on November 12, 2008 at 1:53 PM | PERMALINK

everybody needs to share the cost.

I hang my head in shame. Instead of an end to partisanship we now live in a world where all are equal, all are numbered drones, all are forced to get in antiseptic lines inside of antiseptic buildings with bad lighting and trudge forward, for hours on end, towards an uncertain bureaucrat who stamps papers and denies coverage.

Meanwhile, a single, frail old woman collapses and dies from neglect.

Thank you again, Democratic Party. You just killed granny...

Posted by: Professor Dingleberry on November 12, 2008 at 1:57 PM | PERMALINK

Whole industries in the medical field are likely a large part of a cool cash slush fund for the rich that has been in play for decades. That can be the very reason republicans’ totally are objectionable to such ideas as universal medical care. Here, money saved by the electorate is a change and less money in that trillion dollars slush fund Republican corporate players don’t have anymore.

They are going to have fits, and Mainstream MSNBC Mitchell, very tied to trillion dollar deals will appear to smoothly, calmly, redirect your mind away from the cover up of Allen’s deliberate screw ups. That guy Henry Paulson, what ever, the guy in charge of our treasury, now tells us he has this moving target to deal with. The stuff changes fast. One wonders if he is packing his bags as fast to get out of town. What was really funny is likely an historic copy of the New York Times; we hear thousands of copies printed in the same quality.

Hay, maybe it was not a mistake that stuff will sell better than some stock certificates. Plus the prophecy of Bush the first President in recorded history likely indicted for crimes against the Constitution. Heck if anyone read David Lindorff and Barbara Olshansky book on the case for impeachment would likely enrage the electorate to the streets then be flooded with the electorate building a wooden frame from which would condemn Bush and Company to be executed by hanging in front of the White House.

Now Tom Foley, the butt head is asking for forgiveness, saying he did not do those sexually explicit actions described. Uhuh, Clinton didn't do anything either just stood there. Warren Hatch another sick label in the Republican Party that should be taken off the shelf by dog label inspectors appeared today. McCain still driven by Jekyll Island money will never change, so how could he create change? Haley Barbour, who speaks as clear we understand the Hayley Comet is telling America how great the Republican Party is going liquefy fuel. Actually it would be a good ideal for Palin to look at. Instead of a Pipeline, “Tube it” put that gas in tube containers get into the fuel cell stuff it would create a lot more jobs. It is a plus because the industry is going to do it anyway for advanced fuel cells. But the knuckle head she is likely will not.

Posted by: Megalomania on November 12, 2008 at 2:00 PM | PERMALINK

We need a direct health care system - access to health care for all. Not access to insurance. If all Americans are to have opportunity for health care, there is no point in keeping the insurance industry in the middle as expensive gatekeepers to who gets care and when.

Posted by: ghillie on November 12, 2008 at 2:00 PM | PERMALINK

Megalomania, please. You're not me. You'll never be me. So please stop.

I am a medical professional, I went to Harvard, and I'm the only one capable of being the smart one here today.

Posted by: Professor Dingleberry on November 12, 2008 at 2:05 PM | PERMALINK

What I like about it that it has a government insurance option available to everyone, and at least some regulations to reduce private insurer cherry picking.

The government insurance will, over time, out compete and marginalize the private insurance industry.

Once half the population (the old, disabled, veterans, the poor, lower income children) are getting government insurance paid for with taxes and most of the other half is paying for the same thing I think we will make rapid progress toward single payer universal health insurance.

This would leave us with what seems to be the best health care system: universal mostly government funded insurance and mixed public and private providers.

Posted by: JeffF on November 12, 2008 at 2:06 PM | PERMALINK

Geez Dingleberry! How many times have you seen THX 1138, anyway?

Posted by: Blue Girl on November 12, 2008 at 2:07 PM | PERMALINK

Just because I don't "get" your obscure cultural references does not mean that I am not a medical professional with vast expertise on this matter. In fact, it only goes to show that the liberals would rather change the subject, attack someone and their lack of "cultural" knowledge, and shoot crooked, wry grins at one another in a crowded room.

Rub your greasy chins and laugh. I do not care. Communism means that you will soon be eating bread made of sawdust and wearing shoes made from carpet.

Posted by: Professor Dingleberry on November 12, 2008 at 2:15 PM | PERMALINK

Peofessor Dinglebrains. I doubt if you went to harvard and even if you did so fucking what. If I'm not mistaken the current potus was an ivl league graduate and by an objective measurements he has been a complete and utter failure. Besides what your talking about is more akin to feudalism not capitalism.
Further my U of Michigan graduate friend(summa cum lauda by the way) just returned from Canada( by your measuements a deeply communist country) and remarked how satsified everyone was with the healyh system they have in place.

Posted by: Gandalf on November 12, 2008 at 2:17 PM | PERMALINK

dingleberry, you're so full of shit it's oozing out of your comments. i've never seen anyone so stuck on themselves in these comments before. i work for a municipal trust that deals with providing insurance to members, and most of the medical professionals that i have dealt with know nothing about health insurance, other than how to submit claims. for you to claim you're the only one capable of being the smart one here is a huge joke.

Posted by: just bill on November 12, 2008 at 2:18 PM | PERMALINK

Mr. Gandalf, calm down and learn to spell. Perhaps then, and only then, will I pause to consider nothing you've had to say today.

Posted by: Professor Dingleberry on November 12, 2008 at 2:19 PM | PERMALINK

Please don't feed the trolls.

Posted by: AJL on November 12, 2008 at 2:19 PM | PERMALINK

most of the medical professionals that i have dealt with know nothing about health insurance, other than how to submit claims.

This is where you reveal the ignorant side of your face. { s i g h }

Medical professionals, such as myself, employ billing professionals and medical transcriptionists to code or process our billing. They process the thousands of forms filed each day in a hither-and-yon sort of way. I am uninterested in that process so I cannot speak to it with any kind of precision as to the nuts and bolts. The upside is, because I am not concerned with the mundanities of such things, I can focus on important matters.

We hire people who are trained to perform the basic tasks of billing, invoicing, and tracking claims through the near-perfect system that we currently enjoy. A good service, and I do employ a very good service, is able to process the medical billing at a reasonable cost with an acceptable error rate. This is capitalism. Efficiency exists because that is the incentive of the medical billing professional. If the medical billing professional were allowed to do slipshot work, I would fire them.

When we encounter what I shall euphemistically call a "liberal-minded deadbeat" who refuses to pay, we simply forward that on to another person, who may or may not be at a collection agency.

I do not dirty my hands with forms and paperwork. I am a medical professional, and saving lives is what I do.

Posted by: Professor Dingleberry on November 12, 2008 at 2:25 PM | PERMALINK

Folks, Dingleberry is a troll doing a poor imitation of the parody Norman Rogers. Stop responding to it and it will quit posting.

Posted by: Jeff II on November 12, 2008 at 2:49 PM | PERMALINK

Dingleberry, if you were in my first-year writing class, you would fail. You give no evidence other than the anecdotal, and then make leaps that even Superman could not support from anecdote to universal claims. You use terms without defining them and so use them idiosyncratically, and you show a radical unwillingness to engage thoughtfully with the arguments of others. Most woefully, you show a mind that is set on what it will believe, no matter what.

It is your willingness to spout, rather than engage, that is what I was hoping we would be able to move beyond with the election of a president who thinks.

So please go back to a first-year writing class, preferably at a small community college, where you are most likely to have teachers who care deeply about their students but who also know bs when they see it and are not interested in developing know-all blowhards.

Posted by: mossie on November 12, 2008 at 2:51 PM | PERMALINK

Meanwhile, yes, sorry: Can we talk health care rather than insurance?

From one who is lucky to have coverage for now but for whom that means a wallet with 25 cards in it for all the various plans (each with its different deductibles and coverages), I would honestly like that single payer thing.

Posted by: mossie on November 12, 2008 at 2:54 PM | PERMALINK

I am doubled-over, laughing. The one person who is a healthcare professional is derided while the moronical rantings of profane liberals is lauded as debate.

When I graduated from Harvard, I was told that the world is unkind to the wise, fair to the average, and will be inherited by the meek. I see all of these things at work and I will explain why there is no need to change our medical coverage system--the uninsured simply haven't acquired the means by which they can buy into our current system.

If our economy is wrecked by a President Obama and his socialism, then MORE will fail to have health care, not less. If our economy were to grow, MORE would have health care, not less.

When the American economy is allowed to practice capitalism, it flourishes. When it is wrestled to the ground and beaten to death with a hammer and sickle, it doesn't flourish, does it? No, it does not. It dies. No matter what a health care professional like myself is capable of doing, we cannot bring it back to life. We are not miracle workers.

I implore you--embrace capitalism. Avoid socialism. It's better.

Posted by: Professor Dingleberry on November 12, 2008 at 3:31 PM | PERMALINK

You have to have universal participation if you want universal access. Period. As a retired, former chief actuary for a national live and health insurer I've some experience in these matters and I can say this with confidence.

As a commenter above already observed, we have examples of mandated participation, like automobile insurance, unemployment insurance, Social Security and Medicare, and they all work well. Those who can't afford health insurance need assistance, of course.

We need to remember - we are all covered now at least partially. Nobody will be denied treatment if he's run over by a truck or has a heart attack. But many of us don't pay for it, and that's not fair to the rest of us. Many of the uninsured 47 million are not victims, but opt out voluntarily, betting that they won't need care. But sooner or later they will, and they will have gotten it for free.

We are all interconnected in this advanced society of ours, and what we do impacts others, and we have to take responsibility for it. The days of "It's my body and if I want to abuse it by smoking it's none of anyone's business" are gone. It is my business if you get lung cancer and don't have the means to pay for treatment (which almost no one does) and never took out health insurance.

The best approach is nationalized health insurance, but that's not possible in this country at this time. I'm not even confident that Obama's private, expanded plan is feasible in our society, and I think he ought to concentrate on energy first.

Posted by: hark on November 12, 2008 at 3:40 PM | PERMALINK

Universal, single payer, not for profit, eff insurance. Is it really too much to ask for? If the rich ones want cosmetic makeovers for vanity reasons, they can get supplemental plans, via insurance, why not. But, basic health care? The Sunday magazine of the Washington Post had an article about a yearly, volunteer-ran, "medical fair", which comes to Virginia, to cater to the uninsured and under-insured in the rural areas. Compared the situation to Africa and South America and not, necessarily, in complimentary terms. That's what we want to keep as the badge of our "superiority"?

Posted by: exlibra on November 12, 2008 at 3:42 PM | PERMALINK

I live in one of the countries of Old Europe, and I can tell you from direct experience that it is a mind-boggling experience to live somewhere where your health is more important than how much it costs, or which bean counters will have to re-calculate profit margins because of another patient. The horror stories circulated in the USA about socialized health care are pure and simple bullshit, folks. Tank it from someone who knows. In the country of my current residence, everybody is covered - EVERYBODY. Get it ?

Posted by: rbe1 on November 12, 2008 at 4:44 PM | PERMALINK

It's not rocket science. The USA spends twice as much per capita on health care compared to countries with single-payer, and we get poorer outcomes. Why we're even considering byzantine plans to continue to subsidize the parasitic health insurance companies is a testament only to the corruption of the legislative system. Enough already! Kick them to the curb and do it the way civilized nations do it.

Posted by: President LIndsay on November 12, 2008 at 5:08 PM | PERMALINK

Let me state this straight up: I'm for these kind of plans (maybe with some variation) and voted for Obama, but I don't see how we can possibly pay for this right now. The seeming pile of crap Bush has left on Obama's desk seems like a strongly limiting factor - and I'd love to hear what people think about that.

Posted by: inthewoods on November 12, 2008 at 8:10 PM | PERMALINK

Dingleberry has been skimming drugs from his professional stash.

When "health care professionals" (with Harvard degrees) are worried about the loss of capitalism they mean they worry that they will have to settle for being millionaires instead of muti millionaires. Whatever happened to medical professionals who chose a career to "help people"?

The horror stories are a variation of the "be afraid, be very afraid" meme of the Republicans aka "give me what I want" or you will die.

Posted by: Always Hopeful on November 12, 2008 at 11:27 PM | PERMALINK



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