Saturday, April 19, 2014
The Montana Democrat's plan won't create a government-run insurance option to compete with private companies. It won't provide enough in the way of subsidies to middle-income people who don't get insurance from work and can't afford to buy it on their own.
It won't change the basic structure of our health care system, which is the world's most expensive but not always the most effective. And at $774 billion over 10 years, it won't be cheap.
But, despite the criticism Baucus' proposal is receiving from both ends of the political spectrum, it is worth focusing on what the plan would do: It would start a much-needed process to make health care in America better, fairer and more affordable. And for that reason we think it is the right vehicle to move the process forward.
The lack of bipartisan support for meaningful health care reform has been disappointing, and will ultimately limit what can be accomplished this year. House Democratic leaders were heavy-handed in pushing a bill through their committees that, because of its cost and a variety of other provisions, had no chance of winning Republican support. And many Senate Republicans have seemed more interested in the political advantage they might win by derailing the Democratic president's top domestic policy initiative than in working toward health care reform.
Sen. Olympia Snowe continues to appear to be almost -- almost -- the only Republican in the Senate who could still have a substantial impact on the final package. We encourage her to do what she can to make it into something she can support.
It should be noted that there is still a chance Republican Sens. Susan Collins and John McCain could also play a role ultimately in finding middle ground that would allow them to support a health care reform bill. Both have expressed frustration at what they believe to be the stubbornness of Democrats to be more realistic and to be willing to compromise.
Should members of both parties slide even more to the middle ground on this plan, Collins and McCain might surprise people with their support.
Baucus' plan has its share of flaws, including some that would be felt in Maine. Its funding mechanism, for example, calls for a fee for ''Cadillac'' insurance plans -- a provision that could affect regular policyholders in Maine, who pay some of the highest insurance rates in the country. The plan would also send federal aid to help some states pay for Medicaid expansion -- but not to Maine, which has already expanded its Medicaid program beyond what is required by the federal government.
Still, Baucus' plan would be a major step forward.
Insurance companies would not be able to deny coverage to people who have pre-existing conditions, or to drop coverage of people because they get sick. The working poor and near poor would qualify for benefits under Medicaid that would otherwise have been denied to them. Middle-income people, including the self-employed, would be able to join groups that negotiate for better rates.
Everyone would be required to buy insurance, even the group known in policy circles as ''the young invincibles'' -- healthy people willing to risk going uncovered. That mandate would spread the cost of caring for the sick more broadly among the healthy population. Large employers would be required to provide coverage for their employees or contribute to a fund to pay for coverage for low-income Americans.
Most importantly, it would make the system more fair by addressing the most pressing problem: Millions of Americans have no health insurance and only spotty access to life-saving primary care that can catch a disease early enough to treat it. According to the National Institute of Medicine, 22,000 Americans die every year because they lack coverage.
MORE TO BE DONE
The bill does leave the crazy quilt of public and private health insurance in place, along with the inefficiencies that go with it. The plan also offers only limited cost-control measures. Later reforms must follow, including those focusing on treatments that provide the best bang for the buck and others that would beef up public health programs aimed at keeping people from getting sick in the first place
Our political system is not set up for radical change, and Baucus' approach to overhauling health care would be a moderate, incremental step, not a revolution.
It's up to not only Snowe, but also other members of her party -- particularly persuasive leaders such as Collins and McCain and their colleagues in Congress -- to find a way to work within this structure, understanding that more reforms will be needed down the road.
If nothing else, the plan unveiled last week is more than a start. It is a significant move to finally begin health care reform, which we support.