| As countless others have noted, our senior Senator bent over backwards, watered down his legislation, all in search of a bipartisan bill...and was left with 0 Republican backers. So that's point number one, it is increasingly clear that even Olympia Snowe is going south on even the most agreeable of health care reform offerings. The path to a bipartisan bill is not through negotiations (there is possibly a different path through popular legislation).
That said, there is some praiseworthy material in Max's bill. For example, the public option that people are seeking would "live" in the health insurance exchanges, which are themselves absolutely crucial to meaningful health insurance reform (exchanges will make it possible for individuals and small groups to pool their purchasing power more like large groups and also provide clearer choices for consumers purchasing insurance), are open to a lot more people and employers. In the House bill, for example, you get kicked out of the exchanges if your business grows to larger than 20 employees. In the Baucus bill, you'd have to be given access until you have 50 employees, possibly until you have 100, and eventually anyone would be able to buy-in. In other words, the Baucus bill gives a platform where, with a public option, the option would actually be an option for everyone, individuals, small employers, big employers, etc. That's big.
I'm also a fan of this idea, which I basically think of as insurance reciprocity. Rather than either putting up firm walls that don't let insurance plans cross state lines or tearing down all the walls between states and creating a credit-card-deregulation like nightmare in the insurance system (as Rep. Rehberg and others have advocated), the Baucus plan would allow Montana to permit, say, Californian insurers to sell policies in Montana if we deem California insurance to be regulated enough to satisfy us (note, it might be regulated differently than Montana plans, but still be deemed sufficient by our regulators). Again, this allows for bigger pools and more competition, especially for places like Montana. So that strikes me as good and smart.
The Medicaid and CHIP provisions are also apparently very well-written.
With most other stuff, except for the public plan and a significant change to the employer responsibility section, progressive complaints here are on the margins: subsidies should be more significant, penalties on the individual mandate should be lower, the community rating constraints should be tighter, and the out-of-pocket limits should be lower.
That's all fixable. It isn't fixable without increasing the costs of the bill a bit, but the bill is so fiscally responsible that we can increase its cost and still have it be reducing the deficit (!). So that means we have some room to work.
The bigger problems are that the bill needs a meaningful employer mandate and meaningful competition. Meaningful competition here is a code word for a public option, because no one has yet structured a meaningful alternative to the public option to actually achieve its goals. As is clear, the public option is also a political necessity to building the movement necessary to pass a bill, if the strategy is an outside (pressure) one as opposed to an inside (negotiations) strategy.
There's also some room for feedback on the financing measures, I'm sure, but I haven't really read the relevant material there yet.
Final thought: the biggest problem both with the delivery reforms that Max's bill includes AND with the public option (except for a Medicare-like public option that has its own problems) is that CBO doesn't have a way to score them as providing savings and so presumes that they won't save money. But both Max's Medicare reforms and a real public option will probably result in real cost savings and a public option AND improved access to primary and preventive care will be popular with people. There's some things that can't be scored that easily.
Anyways, check Ezra's five ways to improve this bill. But my friends who are saying this bill needs to die are wrong. It has some excellent stuff in it. It needs amendments, but don't throw the baby out with this bathwater. |
