Thursday, September 17, 2009

The Baucus Blunder

In the wake of the outrageously unfair-to-the-working-poor "reform" plan offered yesterday by Sen. Max Baucus, and the furious response to it on the left, I must admit I'm feeling a tad vindicated.

Some readers of this blog have gotten the mistaken impression that I'm a far-right Glenn Beck-o-phile because my criticism of the various reform proposals, and of some of the president's rhetoric, has often been heated. (I'm a moderate, left-of-center Democrat with occasional libertarian tendencies and an allergy to conventional thinkers, if you'd like to know.) But now that Baucus has promised something fairly similar to what President Obama has proposed, and liberals have come to realize how bad it is, I have to say, "Welcome, progressives, to the realization that it's possible to find this reform plan distasteful without being a 'birther,' a 'deather' or a believer in some other delusion."

I know. You're thinking, "But wait. The Baucus plan stinks because it's a big giveaway to insurance companies and other interests, and it kills the public option." Well, yes, Baucus is even more generous in his largesse to industry interests than the administration had initially planned to be, but the White House started cutting deals with industry groups in the spring. As for the public option, the president has been signaling since last month that he'd be happy to sign a bill without it, so its death was a fait accompli.

I'm not sure why the left is surprised by what Baucus is proposing. Baucus is making a disappointing bill odious, but he's not destroying a good bill.

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To be clear, the Baucus plan is more than a mere giveaway to insurers. By including the individual mandate to purchase insurance, combined with its stingy subsidies AND its death blow to the public option, Baucus is selling out millions of vulnerable Americans. He's forcing people who make as little $32,000 a year to spend as much $4,200 a year to purchase overpriced, underregulated insurance plans, and that's JUST for premiums. It doesn't include copays, drug prices, etc. These folks would be ineligible for subsidies. They'd be ineligible for Medicaid. And if their employer offers insurance, they'd be ineligible to shop for a plan on the public exchange. They would, in other words, be REQUIRED TO BUY their employer's insurance option, almost regardless of their ability to afford it.

So I get how bad the Baucus plan is. What I don't get is why the left thinks it is so much WORSE than what was originally proposed. Every proposal on the table included an individual mandate. None included subsidies for folks earning more than three times the federal poverty line. Industry groups had already cut deals protecting them from most of the provisions that might have had a chance to actually cut the cost of care.

My basic objection to even the most generous reform plans -- even, say, the House plan -- is that they would do nothing to encourage the creation of a competitive insurance marketplace for those of us who already get coverage through work. That's the vast majority of Americans. I want ALL OF US to have access to the same kind of insurance "exchange" that would, under every proposal I've seen, exclude everyone except uninsured American citizens with no other alternatives. That means 5% of us would be eligible for the insurance exchange and/or public option. And that's the plan that the PRESIDENT has endorsed. No wonder the president has been saying that the public option is not that important -- as he proposes it, it's NOT that important.

I say kill the current employer-based insurance system and replace it with a properly regulated individual market where every citizen can purchase insurance, using subsidies and their own money. Forcing health insurers to compete for individuals, instead of competing for large employer groups, would encourage a customer service culture within the companies that would do far more to protect consumers than any list of promises from Congress. It would also encourage cost control since people would better understand the relationship between what they want from healthcare, and what they pay. I'd also add tort reform, a powerful Medicare Payment Advisory Commission -- and, if necessary, a public option.

Individual mandate? I'm for it, but only under the right circumstances. I'll have more soon on how lower-income individuals would fare the Baucus plan's mandate. Sneak preview: not good.


  1. The Baucus plan is nuts. I don't understand why we can't just make it the law of the land for individuals and groups to purchase insurance across state lines. That would instantly lower insurance premiums and force insurers to compete more aggressively with each other.

  2. agree with first comment

  3. The Liberals don't want just to lower the cost of healthcare...They want it for FREE!!!! Ask most Liberal...They want Single Payer.They hate insurance companies -They want MEDICARE for ALL.
    SO if Dr. Bobbs idea worked public option, no single payer. - This is coupled with the fact that insurances don't want competition between states - So win -win for both insurance and Liberals - if Dr. Bobb's plan will not push thru (although I also heard that since each state have different rules/regulations on health might be a problems - though I doubt that reasoning since the Federal gov't/congress can easily turn that.
    I wonder no one debates on this blog - its so boring! I don't think I will read anymore...I want debates (educated and respectful) So I could learn if I was on the WRONG- I don't think I will get it in this blog - so no point in writing further - I have nothing to gain...goodbye - best of luck on this blog.

  4. Hey Anonymous- We don't want free health care, we just see health care as a basic human right. It's not the same as auto insurance. We know that there is enough money in the system now to provide quality health care to all Americans if you stop the insurance companies from putting profits before people. Humana reports $281 quarterly profit from Medicare Advantage plans- how many mammograms or colonoscopies or diabetic training classes would that pay for? The increase in taxes would be more than offset by the decline in contributions by employers in the form of premiums and by patient copays and deductibles and out of pocket expenses.
    Why are you so in love with insurance companies? What have they ever done for you that is so special? Sounds like you fear becoming accountable for your work. Perhaps the fear of a reimbursement decline scares's all about you, isn't it? Forget the asthmatic kids who cannot afford inhalers or the seniors who hit the donut hole and forego their statins and end up with a stroke. Or are you defending the job security of the insurance clerks that deny your authorization for surgery or make you fill out 10 pages of paperwork to get an MRI authorized? Read the proposal to see that funding for retraining of displaced insurance agents is included.
    Don't leave, I'll debate you, and I'll even sign my "name."

  5. Great. I wont leave. No you don't have to leave a name. We are just humans and we tend to get emotional in healthcare thus grudges may develop. This is fine.
    1)First of all...I am not in love with insurance companies. I have no vested interest in them. But I do see their point of view as much as I want to see your point of view.
    2)"We don't want free health care - not the same as auto insurance" - so its ok for you to increase taxes to pay for everybody? (not just medicare and medicaid). Knowing that a lot of our tax dollars are wasted on wars/bailouts/government inefficiencies/Obama's and Bush's expensive parties/private planes of congressmen/etc. So you are confident they will you its right? Good for you if you have that much faith in the system. How much per dollar of taxes do you think is wasted? Do you think its as much as insurance companies make or more? Yes there is a lot of money in the system...but you can't guarantee that the new plan will save far Obama still can't explain how to pay for this other than vague ideas.
    3)So again- Basic human right - also like food, water, shelter? Should the government pay for those as well?
    4) What had insurance done for me lately? They pay more than medicare. You see the different plans, cost, etc. You already know which insurance is better than the other (unless - you are employed Doc since most don't really care ) so they give choice. Profit is ok with me. Excessive profit? not sure. I am not sure how values are set. Usually its supply and demand. Also for excellent service. Would you cut your income to half right now? or do you value your service/education/past sacrifices hence you make more than 3-4 x the average american income?
    Now regarding you other running statements "fear of being declined, not accountable for your work, forget the asthmatics etc." - how did you conclude that on my short note above? - You don't know me enough to make that assumption. I don't agree with these statements since they are not true. Same as you I care for my patients. And yes it tis a broken system...thats why we are trying to solve it...that's why we are having this debate...because we both care.

  6. Hey Siganturedoc
    Just saw the Obama/Stephenopoulos interview Sunday on healthcare and penalazing those who don't have insurance ( hmmm...Obama seemed think skinned there)...he brought up about mandatory healthcare insurance similar to "Auto insurance" - and I remembered what you said. Well if we are applying a rule to health insurance similar to auto-insurance - it seems to me - the difference between the two is getting thin....anyways waiting for your response...

  7. sorry on the spelling-signaturedoc/penalizing/thin skinned

  8. As I suspect - nobody reads this blog other than a few lefty long

  9. Signaturedoc - your a CHICKEN!