Max Baucus' Plan: What Do We Want? Less Quality! When Do We Want It? Now!

The real kicker to the Max Baucus draft plan in today's New York Times is squirreled away near the bottom of the article. The top-line stats include the tax on more expensive health care policies, seen as a way to get at the employer deduction, where a giant pile of money exists in health care. Then there's the mix of expanding Medicaid up to 133% FPL, subsidies inside the insurance exchange for up to 300% FPL, with assurances that people up to 400% FPL would not pay more than 13% of their income in premiums. There is no public insurance option or a trigger for one, and the concept of co-ops is strangely not mentioned at all in the article. There are limits on out of pocket expenses, albeit higher limits than in the other bills ($6000 for individuals, $12000 for families). There's no talk of either an individual mandate or an employer mandate. So there are some holes here, but if it follows the pattern of the other plans, you're ensured coverage if your employer provides it or if you make so little that you qualify for Medicaid. If you're over 65, you're on Medicare. If you fall in between all of that, you go to the exchange, and can qualify for subsidies to afford coverage.

The plan is expected to cost $850-$900 billion over 10 years, but given the coverage subsidies and Medicaid expansion, I can't see that number being so low. Plus the talk in Washington, apparently, is about a $700 billion dollar bill. So how can that all square? By allowing insurers to offer crap coverage.

Coverage under Mr. Baucus's plan would, by some measures, be less extensive than the least generous of three levels envisioned in a bill approved by three House committees.

To compare health plans, experts often focus on the percentage of medical expenses paid by insurance, on average, for a given population. This figure ranges from 70 percent to 95 percent under the House bill's options, but it would be less than 70 percent under Mr. Baucus's proposal.

The only way to keep insurance premiums down for the poor, and therefore keep the subsidies down, is to make the coverage less generous. And the insurers would only pay for covered expenses. Anything not covered by the plan would go directly to the consumer. Someone making $20,000 a year would still be on the hook for up to $6,000 in medical bills under this plan, and that doesn't include their premiums or non-covered expenses. Insurers, then, get off the hook for a huge chunk of medical costs while having to pay a nominal tax, and the goal is actually to have them not pay it at all, but simply to discourage companies from buying good insurance policies for their workers. And you would still see plenty of medical bankruptcies. Virtually everyone's health coverage gets worse under this Baucus scenario. I don't remember "Less Quality Now!" being part of any sloganeering on the reform side.

The real problem is that Washington is choking on the cost of providing health coverage to those who needed it. They don't want to use any external taxes or mechanisms, and they don't want to cut into industry profits to pay for the bill inside the system. So we get an ever-reducing price tag, now around $700 billion over ten years. Ezra Klein notes that these same fiscal conservatives all voted to eliminate the estate tax on ridiculously wealthy Americans, to the tune of $750 billion over ten years. That money would have entirely accrued to the deficit, while Democrats are consumed with being responsible and paying for this health care bill. It's really all a matter of priorities -- help millions of uninsured people get the critical care they need, or give Paris Hilton a tax cut. George Bush financed practically every new program he brought into being by borrowing from China and adding to the debt. But the deficit only matters when there's a Democrat in the White House.

The Baucus plan gives new meaning to the term "aiming low." We'll know by Wednesday if the President agrees.

Follow David Dayen on Twitter: www.twitter.com/ddayen

Comments

[tsobserver]

Brilliant! Insightful!

Tax and spend or borrow and spend. It amounts to the same thing. Borrowing is just another way to tax without calling it a tax. So the only real difference between Republicans and Democrats is just their willingness to call the source of all their lavish government spending a tax.

Will we ever see a day in which the government actually cuts spending? Really cuts spending and gets smaller? Sadly, I doubt that will happen unless we reach a complete collapse of our society in much the same way the Romans did.

[DrInsula]

Greetings from the future! Highlights of tomorrow’s speech:

1) “Congress has been working hard and has produced bipartisan plans for health reform!”
2) “While I would support a public option if we were starting from scratch, we’re not. A more practical solution is co-ops, but they are not an essential part of health care reform. I will sign a bill that will increase competition and choice in the private marketplace.”
3) “Everyone will be required to buy health insurance. Subsidies will be provided for those in need.”
4) “Facing the worst economic circumstances since the Great Depression, doing nothing and failing to pass health care reform is simply too expensive.”

Hope you enjoy it as much as I did (NOT)!

[TerrapinCB]

Another good article by Matt Taibbi on this very subject from 9/3/2009 Rolling Stone:

http://www.rollingstone.com/politics/story/29988909/sick_and_wrong/

[treetracker]

Below is the list who voted for the Kyl-Lincoln amendment. They sure are a familiar bunch by now aren't they.

Baucus (D-MT), Yea
Bayh (D-IN), Yea
Cantwell (D-WA), Yea (finally! supports the public option)
Landrieu (D-LA), Yea
Lincoln (D-AR), Yea
Nelson (D-FL), Yea
Nelson (D-NE), Yea
Murray (D-WA), Yea (supports the public option)
Pryor (D-AR), Yea
Tester (D-MT), Yea

Tax breaks for Paris, but for those of you who live in Paris, IN, Paris, AR, or in the Parish in LA, the Senators' response is "FU," because you are not wealthy enough to be worthy.

[JillQ]

Will someone PLEASE explain to the Repubs why tort reform and having the ability to buy insurance from other states will NOT help reform health care? I hear them say it over and over, but no one argues back. When will someone shut them down?

[treetracker]

Medical malpractice is 1% of the total cost of health care. 32 states have tort reform now, including TX. It as done nothing to reduce the cost of health care. Plus where are all those GOPers "states rights" yahoos complaining about the federal government stepping on states rights to do a federal tort reform law? Hello...any of you out there?

Next issue - selling across state lines. First - interstate commerce laws might be a problem. But for me it's a problem of who would regulate these companies? State Depts of Ins. have authority to investigate insurance companies, regulate them, audit their books, accept and investigate consumer complaints for their citizens and the companies registered to do business in their state. They have no authority to go across state lines to do any of these things. Nor do they have the authority of investigate consumer complaints that happen in another state. My question is if insurance companies want to sell in a certain state, why don't they simply go register with that's state DOI? Think about it.

There is a reason they don't.

Hope this helps, Jill.

[JillQ]

Thanks, Treetracker. But I understand everything you have said. It's the Dem pundits and MSM that hasn't countered the Repub arguments for these things.

My question was to them- where are they and why aren't they calling the Repubs on these fallacious contentions? The more the Repub pundits claim these work, the more uncompromising the Dems seem to be.

[policyhack]

Moderate, reasonable Republicans have been hijacked by the Grand Obstructionist Party. Unfortunately, the have had too much influence on this process.

http://axisofreason.com/2009/09/07/gop-grand-obstructionist-party/

[oldpol2]

The money from big insurance and big pharma has hijacked the votes of congress on both sides of the aisle. The reason it seems different is the mouthpiece of the right is much more vocal and some of their constituents are much less educated. If these congress people do not grow a set and do what's right for the people, we will have to push term limits. One term only!!Do your job and get out. No golden parachute, and the same health care as the citizens.

[Brian Ross - Huffpost Blogger]

Max Baucus never met a campaign contribution that he didn't like.

[Kassandra]

Yeah and the very real possibility of the Supreme Court allowing the corporations to basically and overtly control federal elections with their money and their lies is going to make all thsi legal and out in the open while Americans stand here with our mouths open.
And I can't think of a single thing that will stop them activist judges o' Bush's
Thank you justice O'Connor..­..........­...

[PlaceboStudman]

Somebody please tell me what on earth Insurance-­but-we-cal­l-it-healt­h-care reform is going to do for someone who already has good insurance, and is financially stable enough to pay for whatever treatments and procedures they might require, but has recenty been given the infamous "there's nothing more we can do for you but make you comfortable" speech that doctors give to the terminally ill

[Kassandra]

Maybe pay for the "comfort"? I sure want to have the right drugs when I shuffle off this mortal coil. I'm definitely not into prolonging it, that' for sure.
Other than that, I don't understand how your question pertains to thsi thread at all

[ObamaandClinton08]

Excuse Me...... Mr. Baucus

But I'm not going to be forced into paying some worthless health insurance companies thousands & thousands of dollars a year for BullS*it coverage so the CEO's and the stock holders can make huge profits.

If I'm going to be mandated to carry health insurance, then I want my hard money going towards a "Public Option" that will be efficient and affordable and not to the corrupt insurance industry who adds no real value to health care system other than to rake in obscene profits by denying and rationing health care treatment.

I say let these revolting health insurance companies revert back to selling home, auto and life insurance policy's.

[sino53]

Given what a disaster TennCare turned out to be, and given how costs of both Medicare and Massachusetts' RomneyCare have been soaring, what on earth makes you think that the Government can devise a plan that will be affordable?

It's never happened yet.

Even in Europe, where some countries have single-payer, their costs are rising faster than the rate of GDP growth too.

It can't be helped. It's due to the aging of the population, and the fact that no one volunteers to die just because the health care to extend their life spans costs a lot.

[ObamaandClinton08]

What are you talking about?

Just ask any senior, Medicare works just fine, but it's completely underfunded because we as a country would rather waste trillions and trillions of dollars supporting the bloated budgets of our military industrial complex.

"Even in Europe, where some countries have single-payer, their costs are rising faster than the rate of GDP growth too."

Yeah go ahead and now show me where any one of these European countries have a health-care system that consumes more 16% of their GDP

I will sit back and wait for you to answer me just one question?

What does the insurance industry really bring to the table in our current health-care industry other then driving up the skyrocketing cost to the consumer for the benefits of their CEO's and corporate share holders.

[Kassandra]

Well, there you go, it was Romney's fault. See how easy it is to lay blame????

[tompoe]

Every member of Congress is guilty of dereliction of duty, whatever that is. No Single Payer consideration has harmed American citizens, and the responsible parties need to be prosecuted. If that means, our 2010 votes all go to Third Party candidates, we're still better off than bringing even one of these criminals back for another term.

[treetracker]

Well I will drawn the line at Libertarians. No thanks. Ron Paul is quite enough thank you. I agree with him on about 10% of what he has to say. Beyond that, not a chance.