Baucus Plan: The War of the Pages

Senate Finance Chairman Max Baucus added yet another healthcare reform proposal to the already headache inducing pile. This one, it was pointed out more than once in the news coverage, is only 28 pages.

I don't get it. All through August America's town halls echoed with numbers––page numbers––and echoed is the perfect word, because most of them were just picking up something they heard from someone else. What is this new system that rates bills by numbers of pages, inflated numbers to boot. HR 3200 comes in at only 328 pages. When Senators, Representatives, bloggers, and screaming talk show hosts talk about 1000 pages, they are including all the different proposals. By that count, Senator Baucus just made it 1028. So does that count as simplification or complication?

A complication, definitely. First, the proposal can afford to be short because the main part of it, regulations on private insurers requiring things like guaranteed issue and no denial for pre-existing conditions, is already covered at length in HR 3200. The main thrust of the Baucus proposal is in two areas: Expansion of Medicaid to those without insurance making 133% of the poverty level, and funding to establish healthcare cooperatives. This combination has the additional benefit of appearing to cost $100 billion less than HR3200

This proposal is a sop to those seeking a public option. Here's why they add nothing, and possibly detract from HR 3200.

Expanding Medicaid instead of a public option appears to save money, because Medicaid is only partly funded by the federal government. The rest is funded by the individual states. They also administer the plan under broad government guidelines. I can't imagine that states, many of which are struggling under their own huge budget deficits, will be very keen on this one. As you can see from the report linked to above, overall spending on Medicaid nearly doubled between 1998 and 2003. It spends more than Medicare, which is a government run plan, and the variations in administration make it less efficient. If we're looking to expand an existing plan rather than start a new one, we'd be better gradually lowering the eligibility age for Medicare.

With regard to healthcare cooperatives, I'm not clear whether this refers to medical cooperatives or insurance coops. I covered both in an earlier post and I see nothing wrong with adding some incentives into the bill for those so inclined to try something like this, but both types are difficult to get off the ground and would require more than just money. To provide guidance for start-ups as well as compliance monitoring would, no doubt, require another government agency.

While I haven't seen a lot of detail about Baucus' idea for funding his proposal, what I've read so far sounds reasonable. I don't think any Democrat is against trying to save more money if it doesn't cut back on the number of people covered.

One of the major problems I see with the so-called compromise proposals is that shorter, in the long run, does not mean less complicated. Somewhere along the line it became the mantra of health reform––on both sides––that people want choice. Really? Did you ever try to assist a senior in choosing a Medicare Prescription Drug Plan? It makes choosing a cell phone plan seem easy. As a Benefits Manager, it was my experience that individuals felt overwhelmed by choices in healthcare coverage and would often call may office hoping we could just tell them which plan to enroll in.

That's one reason why I don't see coops of either type getting off the ground. Even on entering an already established coop, individuals will gamble on whether the cost savings today will be there five years later, or whether additional cost equates to more or better care, or whether a lump sum outlay will get as good a return as it would in a standard investment.

Whether 28 pages or 328 or 1028, it's time to stop coming up with so-called compromise proposals that do nothing but complicate the issue even more.

Public Option or Bust?

As noted in my last post and various articles, there is much question whether President Obama will draw a line in the sand for the public option. Most indicators say, no. The thinking on this, I would imagine, is going one of two ways. Appease the conservatives so sometime later on they will concede on something the administration wants––though I can't believe Obama is that naive––or half a loaf is better than none.

Half a loaf is better if the bread is fresh, but what if it's stale? Without a public option what we have is a utopia for private insurers where everyone is mandated to have coverage. They never had any quibble with that part of the reform package, but what incentive is there for them to keep costs down? And if people worry about healthcare rationing under a public plan, what do they think will happen when insurers are forced to community rate and cover pre-existing conditions? They will cut back on services in order to continue making huge profits, but they are not likely to do that in conjunction with oversight panels working toward the best care at the best price.

Maine Senator Olympia Snowe has a put forward a compromise option where the public plan would kick in in any state where private insurers don't reduce costs to a level set by the Department of Health and Human Services. A complaint I've heard over and over is that the House reform bill is too complicated. This would make it more complicated. One of the criteria for rate-setting is location. What private insurers can charge will differ not just from state to state, but within the state, as will the allowable costs of healthcare providers. These trigger points not only need to be set, they will need to be monitored, and I assure you, private insurers will start squawking immediately that limits are too restrictive. Then, as soon as we have a Republican Congress again, the limits will be raised or done away with. Or, conservative governors will say the federal government has no right to impose a public option on their state.

The only way to force private insurers to lower costs is to have a public option that acts as the pace car. It has to be the final line in the sand.

So the question remains, what if the bill can't pass without it? Politically I think it's better for the bill not to pass at all than to pass without the public option. Congress is mistaken if they think their constituents will let reform die this time. Unlike the Clinton years, too many have been following this for too long, pouring their money and their time into the effort to get this done. Many are from the Obama campaign who picked up where they left off after the election. They've been at this for nearly three years and they don't believe in lost causes.Should reform not pass this time these folks (or should I say we) will take to the streets and demand it. We should start by demanding single payer. Next to that HR3200 will look like heaven to conservatives, and we'll be d---ed sure to get real reform passed this time.

Compare Healthcare Proposals

The woman I was collecting signatures with today clued me into this link comparing all the major and minor proposals. The major ones covered are the two Senate proposals and the general guidelines provided by President Obama. In addition there are other proposals that, to my mind, are head and shoulders above HR 3200 or any of the major proposals. They are essentially single payer. The amazing thing to me is these plans haven't gotten a second glance, and yet, of all the proposals they appear to be the only ones with the potential to contain costs, and a clear-cut method for paying for them. Some would require individual buy-ins, others simply impose an across the board tax.

Reading HR3200 Part I: The Missing 587 Pages

Yesterday I visited the website of my Congressman Jim Gerlach (R-PA) and found this:

"Looking for something to read in addition to a dog-eared paperback novel in the waning days of summer?"

I clicked "Read More Story." I'm not looking for something to read. I'm actually behind on my reading due to all this blogging and collecting signatures, but I was game.

It turns out Congressman Gerlach made copies of HR 3200 America's Affordable Health Choices Act of 2009 available in his offices and certain libraries throughout his district.

The Congressman notes:

"This 1,017-page tome may not be as exciting as the titles topping the New York Times Best Sellers List, but the public deserves a chance to read the legislation before Congress votes this fall,” Gerlach said. “That’s why I believe it’s important to make copies of the bill available throughout communities in the 6th District."

Something told me he wasn't really expecting anyone to read the darn thing, let alone understand it. That's why he mentioned the number of pages and "gave away" the ending.

"I hate to spoil the ending for readers. However, the plan House Democrat leadership proposes would allow the federal government, rather than doctors and patients, to make more decisions about treatments ranging from knee-replacement surgery to chemotherapy for cancer patients. The plan also will impose higher taxes and burdensome mandates on small business owners, family farmers and other job creators as they attempt to shrug off the effects of the worst recession in more than two decades. That’s why I oppose this attempt to usher in an era of government-controlled health care that the Congressional Budget Office, the nonpartisan researchers for Congress, concluded would fail to stem the rising cost of health care and balloon our national debt to staggering levels."

Well I decided to call the Congressman's bluff and his office, which is just a few miles from my house, to see about getting a copy of this thing. As noted here many times, I worked in benefits. I had to read and understand ERISA and various other arcane acts of Congress and amendments to the Internal Revenue Code so it didn't daunt me. Unfortunately, I would not have been able to take the copy away with me, which I knew I would want to do since I was sure it would refer to other laws I'd want to check out online, like Medicare. However, as the person who answered the phone helpfully pointed out, the Congressman's page included a link where I could read it online.

I'm about halfway through, and it is going quite well. I'm pretty impressed, and I will keep you posted on what I learn. However, I'm a little confused because the bill I'm reading is only 328 pages! Congressman Gerlach (and he isn't the only one) says it's over 1000 pages. It has been implied by some that the bill is so long and arcane as to cover up what they are really trying to do––which in and of itself is stupid because length leads to precision not the other way around. So what's the deal? If I add on the committee markups (all the specific amendments by House members who want to add things like Autism Awareness,etc) I get another 72 pages. If I include the CBO estimates they add on, say 20 pages. That comes to a total of about 430.

So where are the missing 587 pages that would add up to 1017? Beats me. In between my reading of the bill, which really isn't so bad when you consider about a third of it is tables of contents and about another third is boilerplate stuff, I will have to take a ride over to the Congressman's office and compare his version to the on online.

I'll keep you posted.