Baucus Watch, Part X

Disagreements surface among the Dems

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 tenth of an occasional series of posts on the senator’s pronouncements and how the media has covered them. The entire series is archived here.

It’s Baucus vs. Kennedy, Round One. This weekend’s dispute over the two senators’ separate plans for the much-discussed public insurance option, which would compete against private carriers in the individual insurance market, is a perfect example of a health-care process story—of the horserace genre—that tells Washington insiders which politicos have the upper hand. These process stories are tres important for lobbyists, who need to identify legislative pressure points, and for members of Congress, who may look to party elders for guidance in molding their own positions. But horserace stories don’t help the public understand what’s at stake for them. In 1993-94, these sorts of stories came to dominate media coverage of health reform; it looks like history is about to repeat itself.

On Saturday, New York Times reporter Robert Pear broke news when he wrote:

A significant split has developed between the two Democratic senators leading efforts to remake the nation’s health care system. They disagree over the contours of a public health insurance plan, the most explosive issue in the debate.

And explosive news this was. Kennedy seems to favor a public option that resembles the Medicare program, with the government providing benefits and paying doctors and hospitals the same rates as Medicare, which is to say less than they get from Aetna, Cigna, and Blue Cross. Presumably Kennedy’s version would also let lots of people join. On the other hand, as Campaign Desk has pointed out for months, Max Baucus has long been ambivalent about a public option, which is opposed mightily by insurance companies that have the ear of some members of the Senate Finance Committee. Clearly, Baucus is feeling the pinch from powerful corporate interests.

In March, we reported that Baucus said he considered a public option a bargaining chip to force insurers into making other, less disruptive market-based reforms. In April, he told reporters that a public plan was still on the table, but “it might be a bit on the side of the table.” In May, Baucus said that the legislation coming from his committee would include some form of public option. “I do suspect a version will be in there,” he said.

But what version? Pear’s story suggested that it would differ from what Kennedy has envisioned; Sen. Charles Schumer (D-N.Y.) said as much himself: “It’s pretty certain that Senator Kennedy could not support the Baucus plan, and Senator Baucus could not support the Kennedy plan.” Schumer, of course, has his own plan that may straddle both approaches.

Once Pear’s story hit, Kennedy and Baucus ran for cover, issuing a joint statement affirming their commitment to “seek common ground on health reform legislation despite some media reports to the contrary.” The AP,, Bloomberg, and Politico considered this news, but the “news” of the patch-up didn’t mention the controversial public plan option. Process coverage at its best: first a rift between two Senate heavies, and then a public announcement that they had reconciled. Did they really? That will be left for the press to tell us in the coming weeks.

To move this story—and it’s an important one—beyond the process of reform to the substance of reform, we offer a few questions for reporters:

• Who will really be able to join a public plan—everyone, or just those who don’t have other coverage or are too ill for insurers to take them on as customers?

• Can workers with coverage from their employers go to a public plan if it’s cheaper? In other words, is there a real choice for everyone?

• How will coverage be financed—by taxpayer dollars, or by premiums from people needing insurance?

• Will the government provide the coverage, as it does for Medicare’s hospital and doctor benefits, or will private insurers provide it, as they do for Medicare’s prescription drug benefit? There’s a big difference here.

• What will the benefit package look like? Which special interests are working to make sure that their latest gee-whiz technology gets covered?

• Will doctors and hospitals be paid the Medicare rates, or something higher?

• If they get the higher rates, then where will the cost-savings come from?

• If private carriers provide the benefits with more of the same inefficient billing costs, where will the administrative savings come from?

If the health reform discussion is to move beyond the self-serving rhetoric on all sides, ordinary people need to know the answers.

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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.