Curing What Ails Health Reform With More Reform
Max Baucus (D-MT) likes round numbers.
Max Baucus, chair of the crucial Senate Finance Committee, wrote a health reform plan. Apparently he was expecting it to carry a price tag of around $1 trillion. Instead, the CBO says it’ll cost $1.6 trillion. Baucus could have responded to this by insisting that the CBO is mistaken and he intends to pass his bill with $1 trillion in offsets and prove the world wrong. Or he could have responded with a determination to find $600 billion in additional money. Or a mixture of those two. But instead, he’s promised to cut the bill down to a $1 trillion bill—setting a fairly arbitrary constraint around what happens. That said, you could actually do a perfectly good health care overhaul for not that much money. As Ezra Klein explains:
This CBO estimate could be the first step towards making health reform better rather than worse. Rather than capping the employer tax exclusion, the Finance Committee could end it entirely and convert it, as Ron Wyden does, to a progressive standard deduction. Wyden’s plan, incidentally, was scored by CBO as being revenue neutral in two years and revenue positive in four. Rather than protecting the private insurance system, the Finance Committee could include a public plan with the ability to bargain to Medicare rates, thus saving, according to the Commonwealth Fund, 20 percent to 30 percent against traditional private insurance. Ezekiel Emmanuel, brother to Rahm and health-care adviser to Peter Orszag, has a proposal for a universal voucher system funded by a value-added tax. All these ideas would make health reform better, cheaper, and more sustainable.
The kicker comes in the very next sentence, however, when Ezra observes that “None of them, so far as I know, are under serious consideration.” I complained about this phenomenon this morning already, so I won’t bore you again. But it makes me mad! This is important stuff. Americans are going to have a substantially lower standard of living in the future than we could have in an alternate reality in which more radical health reforms were on the table.
17 Responses to “Curing What Ails Health Reform With More Reform”
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June 18th, 2009 at 2:35 pm
I think it’s time to find Max a primary challenger.
Seriously, what good is a large Democratic majority if it doesn’t equate to a truly progressive agenda.
I for one have no special love for someone just because their name has a (D) after it.
June 18th, 2009 at 2:48 pm
The goal was supposed to be a system of universal coverage where you couldn’t be discriminated against on the basis of pre-existing conditions and where you wouldn’t have to worry that if you lost your job you would loose coverage. Nobody should have imagined that would be free. If Baucus is serious about the $1 trillion price limit and he isn’t going to reform the system enough to get universal care for that price then health care just died. We can primary the guy if we want, but it could be decades before we get another shot at this.
June 18th, 2009 at 2:49 pm
Sahu,
I wouldn’t discourage people from mounting primary challenges, but the cold reality is that Max Baucus is going to be a heck of a lot better for “progressives” than any Republican from Montana would be, and I doubt the Democrats in Montana are going to risk that possibility.
Accordingly, to really get a “progressive” working coalition in the Senate, you need to do one of two things: either change the rules to avoid the filibuster, or get more Democrats elected in more “progressive” states than Montana.
Of course, in this case the rules have already been changed to some extent, since health care reform will go through the budget reconciliation process this fall if something can’t be worked out this summer. And “progressives” are actually just as capable of scuttling anything proposed this summer as anyone else.
June 18th, 2009 at 2:50 pm
Rather than capping the employer tax exclusion, the Finance Committee could end it entirely and convert it, as Ron Wyden does, to a progressive standard deduction.
If people wanted that, they would have elected John McCain, since it is essentially his plan.
June 18th, 2009 at 2:53 pm
Hulk Yglesias mad! Bad health reform make HulK Yglesias WANT TO SMASH!!!!
June 18th, 2009 at 2:57 pm
If people wanted that, they would have elected John McCain, since it is essentially his plan.
If people wanted ONLY that, and nothing else, they would have elected John McCain.
Fortunately, people aren’t that stupid.
June 18th, 2009 at 3:04 pm
DTM,
Oh, I don’t know, Montana has been trending far less conservative lately (I mean, their governor’s no progressive wet dream, but he seems a lot better than Max Profits).
But you’re probably right. We really should be targeting Snowe, Collins, et al. The problem being that, if we ever want even fig-leaf bipartisanship, then we’re not likely to get it by aggressively attacking the precious few moderates left in the GOP.
Maybe we could just stage a Waxman-esque coup and replace him as chairman. It would really piss Max off, but in the big picture, the cooperation of a gavel-less Max Profits is less valuable to the passage of a progressive agenda than the help of a few moderates from the other side of the aisle.
June 18th, 2009 at 3:09 pm
And I still don’t get why the hell the Senate Finance Committee gets to be in the driver’s seat on reform of Health Care.
I mean, don’t we have Public Health and H.E.L.P. committees to deal with these issues?
June 18th, 2009 at 3:28 pm
The trillion, or 1.6 trillion dollars is over ten years. To put it in perspective, the amount by which health care inflation exceeds general inflation will cost us about $8 trillion over the next ten years. We’ll be spending about $35-$40 trillion in healthcare over that period. We’re talking about a 2-3% investment to lower long-term healthcare costs and grant everyone healthcare. The CBO didn’t make any allowances for the bill’s cost reduction measures or . In all likelyhood, the bill will save the people more than it costs the government.
Any “reform” that covers everybody but doesn’t control costs won’t cover everybody 5 years from now.
June 18th, 2009 at 3:37 pm
Sahu,
To clarify, I wasn’t saying a more progressive Democrat could never get elected in Montana. Rather, I was suggesting that just through the benefits of incumbency, Baucus has a better chance of being elected than someone who beat him in a primary, and in turn any Republican elected is likely to be a lot worse for Democrats, including progressives, than Baucus.
Accordingly, if this was an open race or a challenge to a Republican incumbent, I think there would be a lot more room for Democrats in Montana to consider more progressive nominees. I just doubt they would go for giving up the incumbency advantage for that purpose.
June 18th, 2009 at 3:55 pm
The “Democrats” don’t have the balls to confront health care providers over reimbursement & efficiency issues. If they want to prove otherwise, then fine – Obama could be negotiating lower bulk drug prices for the Medicare program & Medicaid programs NOW. Don’t hold your breath.
June 18th, 2009 at 3:59 pm
DTM,
All true points, and a very clear-eyed assessment of the situation. That’s why we need to lessen the power of incumbency (not to mention of corporate lobbyists and self-financing billionaires) by instituting 100% public campaign financing.
It works great in Europe, why not here?
June 18th, 2009 at 4:21 pm
If President Obama wants any legacy other than first black president, he needs to either force real reform (public option or single payer) or veto any bill that comes before him without it. If health reform turns out to mean mandating that I buy health “insurance” from a private company with the sole goal of making as much money as it can, I will be non-compliant.
June 18th, 2009 at 4:30 pm
So many things are wrong! Among them the idiocy of the mainstream media, which mostly ignores major issues but when it does focus on them, briefly, does so incoherently and simplemindedly. The “he said/she said” NPR “news” reports (always weighted toward the Repubs — perhaps because the Dems are inarticulate and/or not shameless?) are enough to make me turn off the radio — last night I heard that Republicans say that healthcare reform would cause 20-30 million people to lose their current insurance and would require rationing, but Democrats say healthcare reform would be a big improvement. And the news analysis is even worse, for the most part.
June 18th, 2009 at 6:08 pm
Re: If people wanted that, they would have elected John McCain, since it is essentially his plan.
Except that the Wyden plan goes a lot farther than that and actually reforms private insurance to requiure them to insure everyone at affordable rates. McCain didn’t even have a ghost of a proposal along those lines. This is not a plug for Wyden, just recognition that his plan is a serious one, whereas McCain’s was a bad joke.
June 18th, 2009 at 6:57 pm
Based on the numbers from the CBO and the Lewin Group I calculated how much cheaper the exchange would be scored if you had a strong and weak public option.
A strong medicare buy in would make it about $250 billion cheaper. A weak public option would make it about $100 billion cheaper.
http://jwalkerreport.blogspot.com/2009/06/public-option-could-save-250-billion.html
June 20th, 2009 at 1:21 am
Perhaps now progressives will finally acknowledge the limitations of their approach to governance.