Matt Yglesias

Baucus Health Plan

One of my first print articles ever was dedicated to bashing Max Baucus so let’s say I’m a Max Baucus skeptic. But earlier today while I was out on the Toblerone Line (anti-tank fortifications, not candy) and the global financial system continued to melt down, he released an ambitious blueprint for health care reform. Such things are too important to be left to someone like me who can’t give it full attention. So consider some links:

• Krugman.
• Volsky.
• Cohn.
• Klein.

All are fairly enthusiastic. Which turns out to be because Baucus’ plan is basically Hillary Clinton’s plan which was basically John Edwards’ plan. And, indeed, those plans were quite similar to Barack Obama’s plan. But Baucus differs from Obama in including a universal mandate to purchase health insurance.

One point that illustrates to me is that it was always a bit misleading to construe the mandate debate as one pitting a “more ambitious” mandate-laden plan against a more politically timid mandate-free plan. Rather, I think it’s better to look at this as pitting two different theories of political expediency against each other. To the man on the street, things probably look better if your plan can be attacked as forcing people to do stuff. But of course to an insurance company executive or his lobbyists, things look better if your plan doesn’t allow the young and healthy (i.e., the actuarially desirable clients) to opt out of buying your product. Max Baucus is not much of a political risk-taker, but he is very attuned to the moods of insurance company interests and feels, plausibly, that the kind of quid pro quid structure of a mandate/regulate plan is the best chance to get things through even if it’s also more vulnerable to rhetorical assault in some ways.

The surprising thing to me, however, is that Baucus’ plan retains the public/private competition aspect of the generic Democratic health care proposal. That’s always seemed to me to be a very important goal that would probably need to be bargained away in order to pass a bill. But Baucus is one of the most conservative Democrats (Johnson, Landrieux, and Ben Nelson were to his right in the last congress) and if he’s really willing to back that idea, and especially if he’s willing to contemplate moving through the reconciliation process, we may well get it.

The Baucus Factor

Ezra Klein takes a look at Max Baucus, one of the most powerful members of the U.S. Senate, and a man who’ll have a mighty hand in shaping tax or health care reform. The story makes me more inclined to believe that a major health care bill will be signed into law, but somewhat more skeptical that a good health care bill will be signed into law. A lot of people seem so jazzed up about the vital importance of passing a bill that they’ve basically committed themselves to agreeing to go along with whatever it is corrupt special interests demand.

Meanwhile, I think these are the key elements to the profile:

His appetite for pork — and his skill at wresting it for his state — is so legendary that The Washington Post branded him a “High Plains grifter.” As one former Baucus staffer put it to me, “He’s like the city councilman for the state of Montana.” And, he’s well known for his tendency to break with the Democratic Party. In 2001, he was so instrumental in passing Bush’s tax cut that he stood behind the president at the bill-signing ceremony, a visual that featured prominently in his 2002 campaign ads. [...] Much of Baucus’ cash comes from the industries most affected by his committee’s legislation. According to the Center for Responsive Politics, this cycle has seen Baucus raise almost $800,000 from securities and investment firms, $565,000 from the insurance industry, and $462,000 from the pharmaceutical industry. [...]

The key event was the 2003 Medicare vote. The original Senate bill had broad bipartisan support, including from such progressive luminaries as Ted Kennedy. But the version of the bill passed by the House of Representatives was a demonstration of Tom DeLay’s ability to wield raw partisan power. The two chambers met in conference committee to come up with a final bill, but Republicans largely locked Democrats out of the process. Only Baucus and John Breaux — two Democrats known and mistrusted for their moderate tendencies — were allowed in. [...] As conservative congressional analyst Norm Ornstein said at the time, Democrats with any loyalty to their party would have said, “If you don’t let in Tom Daschle — our leader, elected by the Senate to be in the room — then we’re not going in the room.” But Baucus and Breaux participated, and the bill passed.

The aftermath of the fight was rough. Many in the Democratic Caucus felt betrayed by Baucus, and there was talk of stripping him of his position on the Finance Committee. Daschle mused publicly about the need to impose more party discipline. But others I spoke to sided with Baucus. Their argument went something like this: The resulting legislation may have been deeply flawed, but it was also the largest entitlement expansion since the Great Society.

To me, that Medicare rationalization is just that — a BS rationalization. Simply observing that a bad bill was also “the largest entitlement expansion since the Great Society” is like a caricature of what progressive politics is supposed to be about. And this makes me worried about bigger picture health care reform.

I’d like to see health care reform in this country. But I want it to be reform that actually accomplishes something — better public health, more take home pay, more labor market flexibility, more economic growth. What I fear is a bill that’d be two parts special interest giveaway for every one part assistance to those in need, while doing little if anything to really address the structural dysfunctions in the system or tackle the roots of our public health problems. Something, in other words, like the 2003 Medicare bill.