Baucus aims for compromise on health treatment

The legislation introduced by Montana Sen. Max Baucus last week has refocused the debate on health care reform, but it hasn’t resulted in the bipartisan support Baucus hoped it would generate. It hasn’t even won the support of Republicans on the Senate Finance Committee that Baucus chairs.

We can’t endorse the Baucus bill, either. The details of it are still trickling out. And many of them are likely to be changed as the legislation moves forward.

But we think it does a much better job than the main House bill in addressing key issues regarding health care.

Most people on all sides of the health care debate agree on a couple of basic issues:

Too many American citizens are uninsured — somewhere between 30 million and 45 million. Rapidly rising health care costs are harming individuals and businesses, and will eventually threaten the entire U.S. economy.

But beyond that, opinions diverge wildly on what needs to be done. The Baucus bill has attempted to find middle ground on those issues, and has made progress in several areas.

First, it drops the public option — a government insurance entity that would compete with private insurers. Instead, it encourages the creation of member-controlled health cooperatives to compete with private insurers. The Baucus cooperatives, however, aren’t generating much support on either side of the debate. Republicans and business leaders fear they could morph into a government-run system, while many Democrats say they wouldn’t really be able to compete with private insurers.

But no one can be sure of that until the co-ops are actually in operation. Some existing co-ops in places such as Washington state, compete very well. And the co-ops couldn’t suddenly become a single-payer, government-run insurance system without additional legislation, which is sure to be vehemently opposed then as the public option has been this summer.

The Baucus bill also includes insurance mandates that most experts say are necessary if we are going to ensure coverage for all American citizens. The legislation would require people to buy insurance and would fine them for failing to comply. There would be subsidies for those with low to modest incomes.

Employers wouldn’t be required to provide insurance for their workers, but those with more than 50 employees that don’t offer insurance would pay fines to the government for subsidies their workers receive.

One of the most important aspects of the Baucus bill is that it is revenue neutral.

According to the Congressional Budget Office, it would reduce the federal deficit by nearly $50 billion over the next decade — if no costly provision are added in subsequent years.

There are already efforts to add provisions, in large part because insurance could be very costly under the Baucus bill for those who don’t receive a subsidy. One estimate is that families could pay as much as $15,000 a year for health insurance by 2016 under the bill. That is too much, and it’s no improvement over the current system. So Baucus and others are looking at ways to reduce the figure.

One way to reduce the entire expense is through cost-containment measures. Here, the Baucus bill comes up short. Although it aims to cut some $500 billion from Medicaid, Medicare and other government programs, it does little to encourage health care providers to cut costs across the board.

There need to be measures that encourage more doctors to put quality of outcomes ahead of quantity of patients seen or procedures undertaken. And there should be provisions to discourage doctors from having a financial stake in firms that offer expensive drugs or own costly diagnostic equipment.

Also needed are measures to encourage individuals to become healthier.

The Baucus bill is being attacked by all sides, one sign that it is an effort to move toward the center in the debate.

There is much that needs to be fixed in the bill, and many amendments will be offered to it in coming weeks. As that occurs, there is no need to rush to meet some artificial deadline.

The Baucus bill is imperfect, but it can be a starting point for an effort to reach compromise on how we treat the sick patient that our health care system has become.


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