Baucus health bill passing: historic progress but unimpressive impact

http://www.kqed.org/epArchive/R910140900

An interesting panel discussion of the recent Baucus health bill passage and challenges ahead. Some points to consider:

- This bill will increase the number of Americans covered by health insurance from ~85% now to 94% by 2014. Is that much to celebrate? And there is very little in the bill that would control costs, increase competition, or help under-insured individuals (some studies have shown that "health care cooperatives" would do little and may not even get off the ground). At least new rules would prohibit companies from rejecting customers based on pre-existing health conditions, but that would probably increase costs.

- Did Senator Snowe incur GOP ire by endorsing the Baucus bill (the only version without a public option currently in circulation) in order to actually help the GOP and pre-empt more liberal provisions such as the possibility of a public option?

- The Republicans have no health reform alternative, absolutely ZERO. They just want to impede action, but by doing so are missing a key opportunity to advance conservative changes. The GOP have spoken for years about reforming and trimming down Medicare/Medicaid, and now they could achieve it by playing ball and gaining concessions from the Dems for yes votes. But instead they are just the "Party of No".

- In order to get the 60 Senate votes to send the bill to the president's desk, all Dems, 2 Independents, and 1 Republican need to vote yes. It could be very close, because Senator Lieberman was not thrilled with the bill (many health insurance companies are based in CT).

- It will be very difficult to reconcile the arch-liberal and arch-conservative wings of the Dem Party, who are both against this middle-of-the-road bill for different reasons. House Dems are irate with the lack of a public option (which they see as integral to "real reform", and they are probably right).

- In order to keep this bill deficit-neutral (or positive), the "Cadillac" health plan tax (taxing the most generous health plans) and/or a tax on millionaire Americans seems inevitable. But unions are against the former (some union members enjoy Cadillac coverage), and the House is against the latter (no one wants to be labeled as a tax raiser prior to the 2010 midterms).

- By mandating that more Americans get coverage, it would help if coverage was more affordable, but that looks doubtful. And if families who can't afford coverage (even with more gov't subsidies) remain uncovered, they will be fined. On the flipside, the penalty is meager, so this may encourage more affluent people to game the system. While healthy, they will remain uninsured (since that will save them money overall, even after paying the fee), and then only purchase coverage when seriously ill (since they know they won't be rejected). This will of course increase costs to insurers, who will pass that along to us.

- The plan taxes comprehensive, low-cost, long-term delivery health systems such as Mayo Clinic, InterMountain Health Care, and Kaiser Permanente, even though Obama and others have touted those companies as models for reform. Why penalize the companies who are doing it well, and give their more wasteful competitors a pass?

- The financing for this bill is hardly transparent, and relies on many short-term gimmicks to balance costs. So even if it passes to law, it is likely that we will be doing this all over again in the near future. Also, the bill expands Medicaid eligibility (covering 11M more Americans, which in theory is good), which will be supposedly 90% covered by the feds. But states would still be on the hook for 5-22% of their own costs (which would range in the billions, depending on numerous factors). As we know, most states are in terrible financial shape, and the bipartisan National Governor's Association came out against the Baucus bill. The bills in the House would cover Medicaid expansions 100% by Washington.

- There is nothing in the bill to address Medicare/Medicaid physicians' reimbursement modernization. So as Congress is trying to cover more people under Medicaid, more and more doctors are turning away those patients because they make less money from them.

http://www.ama-assn.org/amednews/2009/09/28/gvsb0928.htm