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Maxing out on health reform

Senate Finance Committee Chairman Max Baucus’ unveiling of a health reform proposal yesterday fed speculation about the possibility of Democrats tackling health reform from the get-go of the new Administration.

The Montana Democrat’s proposal is detailed in an 97-page "call to action" document. In his letter of introduction, Baucus says the plan is not a legislative proposal but his vision for policy reforms and the political process.

Baucus says the plan will require an initial investment, but doesn’t name how much. There are no cost figures in the plan, but the Senator writes, "It is my intention that
after ten years the U.S. will spend no more on health care than is
currently projected, but we will spend those resources more
efficiently, and will provide better-quality coverage to all Americans."

The Baucus proposal is very similar to the plan Sen. Hillary Clinton proposed while campaigning for president. Her plan was very similar to Obama’s plan, except that Clinton wanted to require people to buy insurance and Obama opposed such a mandate.

Regarding the mandate, Paul Krugman writes
that Obama’s opposition during the campaign was largely tactical
politics and "so he may well be prepared to do the right thing now that
the election is won."

Krugman’s logic here is that to achieve true universality in
coverage, and thereby avoid the death spiral of adverse risk selection,
it’s necessary to require everyone to purchase insurance.

Critics of a mandate argue that it punishes those who cannot
afford insurance, which is why Baucus and other supporters
must prove there are sufficient subsidies for low-and middle-income families if
they want support from consumer advocates and unions.

This same battle over the mandate was fought last year in
California. Eventually, opponents realized that if they wanted
community rating and guaranteed issue the mandate was necessary.

Until
the end, however, battles over the level of subsidies remained. Several
Democrats who killed the reform bill said they weren’t convinced
insurance would be affordable. But in reflection, several commentators said killing the reform was less about concern for the consumer and more about politics between the Assembly, Senate and Governor’s Office.

Anthony Wright, president of Health Access a California consumer advocacy group, wrote about the mandate issue yesterday on his blog:

We at Health Access have been skeptical of the individual mandate, but
not opposed to the notion that we all–sick and healthy–should
contribute to health coverage (as many health reforms, including
single-payer, include). Rather, our issues were more about the problems
in the inefficient and inequitable individual insurance market that
some may be forced into. It was only in the context of expanding group
coverage, shrinking the individual market, and placing new subsidies
and restrictions, that we and other consumer groups supported AB x1 1,
the negotiated deal between Governor Schwarzenegger and Speaker Nunez.

Politics of health reform at a national level will be no easier. The
Senate will have to secure 60 votes, and true reformers will have to ignore the cash pouring in from lobbyists.

I’ll admit that I’m somewhat glad the Clinton reform effort failed in the
1990s, when I was too young to care about health care. Now, I’ll have a chance to watch the sequel.

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H. GreenMD as HELLAromatherapy OnlinejdH. Green, MD Recent comment authors
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H. Green
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The VA and Department of Defense are Socialistic Health Care delivery systems where the doctors are employed and the hospitals are owned and run by the government. Single payer national health insurance based on Medicare would allow doctors and hospitals to remain private. Single payer national health care would also redirect the $750 Billion dollars a year that private health insurance companies waste for administrative purposes back into the hands of hospitals, doctors, nurses, therapists and pharmacies.
http://www.pnhp.org/news/2008/february/what_government_does.php

MD as HELL
Guest
MD as HELL

Don’t tell me you have a realistic proposal to revamp all of healthcare when the Department of Defense and the VA systems are a total joke!! Run those first. Don’t tell me you can cover everyone, because you don’t cover everyone you say you cover now. You can envision all you want, but you haven’t defined what it is you are proposing: What is “healthcare”. Define what it is you mean. If you mean access to the “system” we have, the reformers say that system is broken. Why would you want anyone to access a “broken” system? On another blog… Read more »

H. Green, MD
Guest
H. Green, MD

60% figure, Annals of Internal Medicine, 2008.
Survey based on the AMA physician Database.
$700 Billion insurance company wasteful overhead, well documented for years, check following website
for references…
http://www.pnhp.org
60-65 Million uninsured.
40 million under-insured
Single payer infrastructure already exists almost all physicians, hospitals and clinics in the country contracted with Medicare and electronically connected. Needs to be technically upgraded.

H. Green, MD
Guest
H. Green, MD

60% figure, Annals of Internal Medicine, 2008.
Survey based on the AMA physician Database.
$700 Billion insurance company wasteful overhead, well documented for years, check following website
for references…
http://www.pnhp.org
60-65 Million uninsured.
40 million under-insured
Single payer infrastructure already exists almost all physicians, hospitals and clinics in the country contracted with Medicare and electronically connected. Needs to be technically upgraded.

Aromatherapy Online
Guest

good site, Its first time I am visting your site. keep posting good content.

jd
Guest
jd

Deron was being kind. Dr. Green’s list of “facts” was off the wall. Lowest mortality rates of any health insurer? $700 billion to $1 trillion in insurance overhead? That’s just sloppy.

Deron S.
Guest

Dr. Green – With all due respect, many of your points don’t make sense or have a lot of spin behind them. Your point #6 is very odd to say the least. I didn’t know that 100 million Americans were uninsured and I also didn’t know that insurance company bureaucrats could care for patients. I also question your 60% of physicians figure. I would love to know a little more about the sample that was used to arrive at that. If it sounds like I’m giving you a hard time, it’s only because single-payer would be a major undertaking with… Read more »

H. Green, MD
Guest
H. Green, MD

The Call to Action/Health Care Reform 2009 proposal released 11/13/08 (http://www.finance.senate.gov/) by Senator Max Baucus is a disaster. The Baucus plan is an expansion and continuation of the status-quo mixture of a government subsidized ineffective private health maintenance insurance industry operating parallel to and within Medicare Insurance. 7 Specific Reasons Why the Baucus Health Reform 2009 Plan Fails….. 1) The Baucus plan fails to enroll all Americans in a single payer National Health Insurance such as the most efficient health insurance plan (Medicare) which is already contracted with most doctors, hospitals and clinics in the Country. Medicare has the lowest… Read more »

Deron S.
Guest

I won’t comment on whether mandates are a good thing, or whether single payer is the magic bullet as some claim. I will just balance out this argument by saying that we can’t do anything that increases utilization of healthcare services without first addressing the serious issue of our battered primary care delivery system. Successful reform has an order of priorities associated with it. If we go out of order, we risk creating even bigger problems than we have now.

Ron
Guest
Ron

The Baucus plan too closely mirrors the current horror show playing out in Massachusetts. The MA scheme has done nothing to decrease the ever escalating costs of healthcare nor has it improved the quality of delivery. The “individual mandate” is severely punishing the middle class and depressing the state’s economy overall. While the plan has been a boon to insurers and some large health systems, it is a huge consumer boondoggle! I agree with Peter, let’s just move to a single payer system financed by an equitable payroll tax and get it done.

Peter
Guest
Peter

“Critics of a mandate argue that it punishes those who cannot afford insurance, which is why Baucus and other supporters must prove there are sufficient subsidies for low-and middle-income families if they want support from consumer advocates and unions. The critical point here is; what is the cut-off income for subsidies? Is it graduated or just a financial cliff? How about there is NO cut-off, we just insure everyone and implement a health tax based on income that can be determined from exsisting tax returns. And do away with this notion that we have to risk pool regions/states/groups to arrive… Read more »

MG
Guest
MG

http://www.reuters.com/article/newsOne/idUSTRE4AB67T20081112?pageNumber=1&virtualBrandChannel=10112 So basically PWC answered the question with their recent analysis on the Obama healthcare plan – $75 billion next year and much continued spending in the near-future with long-term savings. Baucus plan is very similiar so it is safe that the price tag in the first year alone will be $75 billion at least and likely to be even greater than predicted because their are no true cost controls. So the question is this – does Congress come up with another $75 billion next year (and probably close to $100 billion in 2010) to expand enact the Obama healthcare… Read more »