Max Baucus's Not-That-Bad Health-Care Bill, and His Not-That-Great Health-Care-Reform.
How you'll judge Max Baucus's framework depends on how you understand the goal of health-care reform. Insofar as the effort is aimed at filling in the cracks of the current system — making it more affordable, more transparent and less cruel — it's not a bad bill.
The legislation really would protect millions of Americans from medical bankruptcy. It really would insure tens of millions of people. It really will curb the worst practices of the private insurance industry. It really will expand Medicaid and transform it from a mish-mash of state regulation into a dependable benefit. It really will lay down out-of-pocket caps which are a lot better than anything people have today. It really will help primary care providers, and it really will make hospitals more transparent, and it really will be a step towards paying for quality rather than volume.
To put it more starkly, it really will be the most important progressive policy passed since Lyndon Johnson. The subsidies should probably sit at 400 percent of poverty, and the employer mandate should be reworked, but such failures are relatively easy to fix, and may well be patched over by the time the legislation arrives on the Senate floor. The fact that a bill of this size and scope can still be considered disappointing is evidence that the doors of the possible have been thrown wide open.
The main disappointment is that insofar as you see the bill as a vehicle for moving us towards a better, more efficient, less costly system, there are some problems. In particular, this bill seems to block off a lot of its own possible points of expansion. The health insurance exchanges are limited to the state level, and appear to split the individual and small-group markets apart from each other. There's no mention of a possible expansion toward larger employers, either. Similarly, the co-op plan is an interesting policy proposal, but unlike a public insurance option, it's difficult to imagine it growing into anything significantly stronger than what's outlined in the paper.
The early reaction to Baucus's bill has been overly negative. It's an imperfect improvement to the current system, but an improvement nevertheless. Where it really falls short — even in comparison to the rudimentary framework released by HELP and especially when compared to the more complete package offered by the House — is in imagining a system that is different and better and fairer than our own, and working to make it a reality. Baucus talks often of building a "uniquely American" system, but this proposal largely plugs some holes in the one we already have. As such, the failure is not so much in the bill as in its unwillingness to lay the groundwork for the bills that may need to succeed it.
Photo credit: By J. Scott Applewhite — Associated Press