Baucus Watch, Part II

What’s really inside the senator’s health-care white paper?

As chairman of the Senate Finance Committee, Senator Max Baucus holds the keys to health-care reform; any health-care legislation must pass through his committee. So what he says or doesn’t say is important to those following the twists and turns of the congressional effort to fix our health-care system. This is the second of an occasional series of posts on the senator’s pronouncements. The entire series is archived here.

The senator from Montana brought forth Wednesday what he said was a “Call to Action,” an eighty-nine-page white paper that catalogued the ills of the U.S. health-care system and offered prescriptions—some more vague than others—for treating them. Baucus said the paper, which was not presented in the form of legislation, was the next step after his listening tour in Montana and the nine hearings he held earlier this year. “The health system is so complex that any solution will demand time and attention to make sure we get it right,” Baucus said. “This plan is most certainly a work in progress.”

Baucus fans in the media cheered. Kevin Drum at Mother Jones wrote, “I give serious healthcare reform an 80% chance of passing before June.” Wow! But didn’t Baucus say reform would demand time to make sure we get it right? And didn’t president-elect Obama say that the economy and energy policy will take precedent over health care at the moment? Jonathan Cohn at The New Republic was a little more restrained, but still gleeful. “Universal Coverage: Full Speed Ahead” was the headline on his blog post about the plan, in which he suggested that Baucus would get to work on a bill this year but the question of whether something is actually adopted will depend on politics. Ya think? Ezra Klein at The American Prospect noted that the Baucus policy paper is trying to create a health-reform process and is “the generic Democratic health care plan.”

The Era of Good Feelings has arrived. Even Don McCanne M.D., who blogs for Physicians for a National Health Program and supports a single-payer system, said the Baucus paper contains some “valuable recommendations.” And there was the ubiquitous Ron Pollack from Families USA, whom reporters always turn to for a good quote. This time he told The New York Times that “the prospects for meaningful health care reform have never looked better.” He told The Washington Post, “A president’s leadership is most effective before he expends much of his political capital.”

To me the white paper reads like a catchall wish list—a veritable legislative Christmas tree that offers a glimmering ornament for everyone. Baucus talks of a “high performing health care system.” Those are the words The Commonwealth Fund, a New York City-based research and philanthropic organization, uses to describe its proposals. There’s a section on long-term care, which had been virtually ignored during the presidential campaign. Here, Baucus mentions giving states “new tools and incentives” to make home care more available. There’s talk of making information about cost and quality of medical services more transparent that should gladden the hearts of consumer groups; and for the business community, his ideas sound Republicanesque in spots.

The cornerstone is individual responsibility: People must have coverage, he argues, and if they don’t have it from their employers, they’ll have to buy their own. That’s a combination of Hillary Clinton’s mandate to buy coverage and George Bush’s notion of every man and woman for himself and herself. The Health Insurance Exchange, which was part of Massachusetts’s health-reform legislation and resembles the Federal Employees Health Benefit Program, sprang from the conservative Heritage Foundation years ago when Heritage began pushing the privatization of Medicare. Baucus’s ideas to tax some portion of the value of the health insurance you get from your employer sure sounds a lot like John McCain’s proposal. Although Barack Obama attacked this idea in his campaign ads and in stump speeches, we told our readers that some Democrats supported such a plan.

There’s something for journalists, too, in the Baucus proposals: the challenge to start dissecting exactly what this supposed Democratic consensus document is all about. First, is it really the consensus plan—the plan that consultants have focus group-tested and carefully crafted to avoid ruffling special-interest feathers and to soothe the middle class, assuring that it can keep the insurance it has now if it wants? Blogger Robert Laszewski, who’s pretty sharp-eyed about these things, told me that the Baucus document plays right into his thesis that there is no consensus. Spend two hours reading it, he says, and “you’ll see there is no consensus.”

Sift through it, and you’ll also find a lot of on-the-one-hand, on-the-other-hand language that really doesn’t offer much of a road map. Take the senator’s thoughts on Medicare coverage for people who have qualified for Social Security disability payments. Currently, a person who gets these payments must wait two years before getting Medicare benefits. Baucus advocates a phase-out of the waiting period. “It is anticipated that people with disabilities would also eventually be able to purchase coverage in a reformed health insurance market,” his document says. But is it realistic to think that insurers, with all their clout on Capitol Hill, will agree to stop scrutinizing peoples’ health conditions before issuing policies, especially to very sick people like those on disability? Will they agree let in sick people if everyone else is required to buy insurance, as a few experts have suggested? There’s no consensus on this key point.

Or take malpractice reform. Baucus acknowledges that the Government Accountability Office has found that access to medical care is not “widely affected” by large malpractice premium increases, and that malpractice costs account for less than 2 percent of health costs. But he goes on to say that doctors complain that the legal environment leads to more tests and procedures to avoid liability. That’s the conventional wisdom that the medical community has spread in the last several congressional sessions. We really need journalists to tease apart these discrepancies.

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Trudy Lieberman is a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for The Second Opinion, CJR's healthcare desk, which is part of our United States Project on the coverage of politics and policy. She also blogs for Health News Review. Follow her on Twitter @Trudy_Lieberman.