Baucus Watch, Part XVI

What we should have known all along

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

This week, Sen. Max Baucus finally revealed himself. He did not support a public option—at least not an effective one that would have competed against the commercial insurance industry, paid doctors Medicare rates instead of higher commercial rates, and held out the promise of reducing the health system’s bloated administrative costs. As University of North Carolina health policy expert Jonathan Oberlander told my class last spring, a public option was the only idea in the basket of cost-containment proposals that had any possibility of actually reducing health care costs.

In two separate votes on public plan amendments, Baucus sided with Republican members of his committee, reflecting what has been known for months—that the insurance industry (along with the business community, the drug makers, and the docs) had convinced enough senators to essentially kill a plan that would have disrupted business as usual. “No one has been able to show me how we can count up to 60 votes with a public option,” the chairman announced after the vote. “I want a bill that can become law.” A spokesman for the insurance trade group, America’s Health Insurance Plans, said his organization was pleased. Why wouldn’t they be?

The defeat, of course, was big news, since the public option had assumed a larger-than-life persona, and the media covered it that way ad nauseam. When the plan failed in the Finance Committee, news outlets played the vote straight, but added some interpretive fillips to their stories. The Wall Street Journal proclaimed that the bipartisan Senate vote:

Swept aside demands by liberal Democrats for a government-run health insurance plan, delivering a potentially lethal blow to the most controversial measure of the proposed U.S. health-care overhaul. The two votes suggested that the ‘public option’ is all but dead in the Senate, though it clings to life in the House.

The Washington Post said that the Senate votes dealt “a crippling blow to the hopes of liberals seeking to expand the federal role in health coverage as the cornerstone of reform.” And The New York Times reported that the votes “vindicated the middle-of-the-road approach” taken by the committee chairman.

But to us the signals had been clear from the get-go. The cards were stacked against the public option, and that has everything to do with the political process; the privileged position of American business (identified long ago by Yale professor Charles Lindblom); the way cash splashes around during campaigns; the best lobbyists and advisers that money can buy; the continued fear-mongering and falsehoods about government health care; and, equally important, the equivocations from President Obama himself. Watching Baucus over the months shows that the politics of health reform are what they always have been.

Last November, about the time we began our Baucus Watch series, I interviewed retired Yale professor Theodore Marmor for the first post in our Excluded Voices series. Marmor was pessimistic that there would be a public option. He told us:

If it were possible to get enough political agreement to get an attractive public plan to dominate, it would really be possible to get something more straightforward. Supporters have a naïve but earnest hope that a “Medicare-like” public plan will be a stepping stone to a dominant public program for most Americans. Those who oppose it will fight like hell to make sure that the stepping stone does not become that attractive.

Throughout this year, Baucus sent signals, dropped hints, and occasionally acknowledged that the opposition was fighting like hell. From an early Baucus Watch post which reported that Baucus said lobbyists “really care about our country;” to one that said he considered a public option as a mere bargaining chip to force insurance companies into accepting other reforms; to a post noting how he had ordered the eviction of single-payer advocates from his hearing room; to last week’s Baucus Watch which revealed that he would place online only his bill’s conceptual language, not the actual language; it was obvious that the chairman did not favor a public option, and perhaps was listening to the health care interests which had given him gobs of money, and to the ex-staffers now employed by those interests.

Still, progressives and their lobbying organizations held out hope, and some actually believed that a public option would prevail. Writing on The Nation’s Web site, John Nichols noted that the health care debate “has already provided more than enough disappointment for Americans who recognize the need for a thorough reordering of the way in which this nation meets the medical needs of its populace.” Without Democratic support on the key Senate committees, health reform “will not advance,” Nichols said. “What we will get, at best is insurance reform.”

That appears to be what the Senate Finance chairman had in mind all along. “We got Baucused,” one single-payer advocate remarked after the vote, further explaining: “I guess his name is now a verb: kind of like bend over because you just got Baucused.”

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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.