Baucus to Push Health-Care Overhaul

[question everything]

Source: WSJ

NOVEMBER 12, 2008

By LAURA MECKLER

WASHINGTON -- The chairman of the Senate Finance Committee on Wednesday will release a sweeping proposal to overhaul the health-care system that largely reflects President-elect Barack Obama's vision, increasing the chances for action next year.

There is one important difference between the initiative coming from Montana Democratic Sen. Max Baucus and the plan Mr. Obama laid out during his presidential campaign: Mr. Baucus would require all Americans to have health insurance, while Mr. Obama has rejected the idea of a mandate. In that respect, the Baucus plan reflects the one put forward by Sen. Hillary Clinton during the Democratic presidential primaries.

(snip)

Like Mr. Obama, he proposes a national marketplace that he dubs the Health Insurance Exchange, in which individuals and small businesses could buy coverage, with subsidies based on income. Private insurers and a new Medicare-like public program would compete through the exchange to offer coverage. Some Republicans have complained that such an approach gives government too heavy a hand in the design and sale of insurance. Under the Baucus plan, most employers would be required to offer insurance to their workers or pay into a fund, with the contribution based on the size of the firm and its annual revenue. Small employers would get a tax credit if they offer insurance, with the size of the credit based on the size of the company and its earnings.

The plan doesn't say how large or small companies would have to be to fall under these rules or qualify for the credit. It also doesn't provide a cost estimate, and a Baucus aide declined to give one. The plans proposed by Sens. Obama and Clinton were each estimated to cost about $100 billion a year, not accounting for savings they hoped to generate through new efficiencies in health-care delivery. Mr. Baucus, too, proposes a slate of ideas for reducing costs and improving quality. Many of these ideas enjoy bipartisan support. The document reflects Mr. Baucus's thinking, but an aide said the senator hopes to begin building bipartisan support for it immediately. He hopes to begin with meetings next week with leaders in both parties of his Finance Committee and the Senate Health, Education, Labor and Pensions Committee. Sen. Edward Kennedy (D., Mass), chairman of the HELP Committee, is expected to play a major role.




Read more: http://online.wsj.com/article/SB122646150211820091.html

[sandnsea]

1. Why not make it a right

for all Americans to have, and then work the program from there. Mandating people to buy insurance will never pass, it's DOA. I can't believe Baucus, of all people, doesn't understand this.

[BrklynLiberal]

2. Sounds like a good beginning...

[demodonkey]

3. If it's not single-payer, it's NO GOOD. Everybody in, nobody out. HealthCARE, not "insurance".

HealthCARE must become a basic human right in this country if we are to stay competitive with the rest of the industrialized nations.

And that means full coverage for ALL, including long term care for the disabled of any age.

No more greed-driven "insurance" programs -- no, it has to be real healthCARE for all Americans.

[kath]

12. Agree - insurance companies have got to go. Single-payer.

Let the insurance companies sell homeowners, life, car insurance, etc. But they need to be OUT of health care.

[cali]

14. Sorry, t that's not going to happen

as Pema Chodron says: "Start Where You Are."

An abrupt shift just isn't in the cards. Not with the Congress the way it is and not with Obama as president.

it's been clear to me for a while that the only way to get single payer is to go through a long reform process.

Wish it weren't so, but as they say, reality is a harsh mistress.

[John Q. Citizen]

24. So we need to fail longer on health care to finally succeed when we are all dead?

not much of a plan you have there.

[question everything]

26. I think that it will have to come from the business people

As long as employer have to pay the premiums they are still the ones carrying the load. And they are the ones facing the increase in premium every year. If CEOs of corporations will come to the table, it will not be viewed as "socialized medicine." Remember what happened when the Clinton administration tried it. We lost Congress a year later.

[John Q. Citizen]

30. Yes, I was there when Hill tried to institute big insurance backed managed care.

of course the business people (with the exception of the chosen insurance companies) and care providers and hospitals and patients (us) were against it.

We had no say in the plan.

It has to come from a lot of different sides at the same time. And we have to do what will work for the greatest number of people in this country, not cling to worn out ideology that doesn't make health care affordable, available, with choice of care provider for everyone.

We are already spending way more than enough to cover everyone.

[demodonkey]

43. Well dammit it HAS to happen!! The insurance-driven system we have is not sustainable.

We can't keep giving this huge portion of our GDP to these health insurance paper-pushers while 18,000 people die every year just because of this.

Congress and all of us better wake up and smell the coffee.

[Wizard777]

4. So Baucus wants to jail people for not having health insurance?

I think I like McCains idea better. He would just send the uninsured to emergency rooms. I mean dayum. Jail? :wtf:

[sandnsea]

5. I missed that quote

Could you please provide it for me. Thanks.

[Wizard777]

15. Mr. Baucus would require all Americans to have health insurance,

Here in Maryland we require all drivers to have automobile insurance. If you drive uninsured. They will put you in jail. In fact it's an automatic arrest to which an officer cannot use discretion. He must arrest you. I'm assuming required health insurance would work the same way. If not. Then how are they going to enforce the requirement?

[prolesunited]

17. You're making a HUGE assumption

that I'm sure has little bearing in reality.

And how many people do you think would forgo insurance if it was affordable and accessible. I'm sure the millions of insured in this country would jump at a chance to get coverage.

[Wizard777]

28. He's saying require to have. I would be more comfortable with require to provide.

If they go with require to have and you don't have. What happens? Fill in the blanks with your assumptions. I'm assuming the Insurance lobby would love to have a pay me or go to jail market. Talk about a captiev customer. No I don't need a bail bondsman. I need a insurance agent to get me out.

[prolesunited]

29. Yes, they are going to build huge prisons

to house all those insurance scofflaws. :eyes:

[sandnsea]

25. How absurd

There are all kinds of requirements in law that don't include arrest when violated. You're required to have a building permit, they don't arrest you if you don't. You're required to carry unemployment insurance and workman's comp. Various jobs require licenses, but they don't arrest you if you accidentally let it lapse. Get real. This is just the kind of stupidity the right throws around to scare people. I don't support mandates because I know what government thinks people can afford is way different from reality, but to say people are going to go to jail does not help at all. Do you not need some affordable means to provide for your health care?

[Wizard777]

32. I agree it's absurd. But what is the remedy? How do you compell the requirement?

You practise medicine without a license and you will be arrested. Here in Maryland you can be arrested for doing home improvements without a license. Unemployment insurance and workman's comp. are handled as civil matters. But lets go that route too. You don't have health insurance and you get hit with fines, penalties, late fees, and interest. The next thing you know you have a bunch of homeless people with health insurance. But knowing how the government likes to do things. You'll probably end with people that lose their homes to the fines, penalties, late fees, interest, and still don't have health insurance. Because that would stop the fines, penalties, late fees, and interest.

[sandnsea]

34. Pay taxes or get penalties and interest

But you don't get arrested unless you're intentionally lying about what you owe. Big difference. It would be a hard enough sell to mandate it if you're only talking about monetary penalties, you don't have to make it completely crazy by talking about jail that is never ever ever going to happen.

[nodehopper]

31. hi, logical fallacy, table for one

in MA it is already required by state law...is it a jailable offense? no. it carries a penalty in taxes.

the country I live in now requires everyone to have health insurance by law...it's not some kind of barbaric practice as long as the health insurance industry is heavily regulated and accessible to everyone...don't fear-monger.

[Wizard777]

35. What are the penalties? Please be specific.

It's the lack of information that is causing my fears. I'm not fear mongering. I'm just expressing my concerns.

Also say the democrats impose civil penalties for this. Then some years later in a republican majority they decide to add criminal penalties to appease the insurance industry lobbyist. I'm 76 years old. I can remember when marijuana was legal. Then came civil penalties. You had buy a marijuana tax stamp. Then the next thing you know they're just locking everyone up for it. When you've lived as long as I have. You realize that sometimes the absurd, like shit, actually happens. You say you already have what I'll call a Health insurance tax stamp act. Using the marijuana tax stamp act which was patterned after the machine gun tax stamp act. How far from being locked up for not having health Insurance are you? I would say about 5-10 years tops.

[nodehopper]

37. okay, no offense, but that's still a logical fallacy

The penalty for not having insurance in MA is $912 for the year, maximum. As someone up the thread pointed out, there are plenty of laws that are enforced through fines, not incarceration.

At the risk of slipping into logical fallacies, or at least anecdotal analogies myself, there are many countries where drug possession leads to incarceration, AND health insurance is required, and failure to have it leads to penalties in taxes. And like I said, I have no problem with mandating health insurance--among other things, it's a public health issue, as long as the industry is regulated and EVEYRONE have access to reasonably priced health plans with no bullshit like preexisting conditions, mysterious insurance drops when someone gets sick, jacked-up premiums. Incidentally, the situation in MA is very far from ideal because they instituted mandatory health insurance WITHOUT heavily regulating the insurance industry, so for a lot of people it's a crapshoot--but the problem is, again, privatized and deregulated health insurance, not the concept of mandating people to have it.

[sasquatch]

6. Why is it that we're still having this problem: Single Payer, EOD

[harmonicon]

7. yep - the only solution

[last1standing]

9. Single payer is the solution but not the answer.

At least its not the answer for today. Everybody knows that we will eventually have to go to a single payer plan if we want to compete in a global market but it's political suicide in today's environment to propose it. In 1993, the AMA, insurance companies and medical companies teamed up to spend $5 billion in a massive lobbying and advertising effort to take down the single payer plan Hillary Clinton had developed and they are quite willing to do it again.

In comparison, Obama spent under $1 billion over two years to win the presidency. Can you imagine what $5 billion in a few months could do? We still talk about the 'Harry & Louise' ads 15 years later.

[question everything]

27. Right. I find it ironic that recently it is the AMA advertising saying that we cannot

have a society with so many people denied health care because they lack insurance. What a difference 15 years make.

Of course, the AMA did not want anything where people cannot see whoever they choose to provide health care... and we got the HMOs that does precisely that. And we have all kind of "consultants" that tell doctors what kind of imaging they can use

http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=222x47107

[last1standing]

8. Baucus is one of the most conservative Dems in the Senate.

To have him proposing a plan like this means there is enough support to really get something accomplished. I'd prefer a single payer solution but I don't think that would get through congress at this point so this works.

[Vinca]

10. I'm not in favor of allowing people 55 and up to enroll in Medicare because

Medicare doesn't sufficiently cover costs for people and should also be reworked or replaced. Seniors who can afford to buy supplemental insurance to cover more of the bills often end up spending as much as someone who isn't on Medicare. A friend's father was spending $900 a month for Medicare and a supplemental insurance policy. As for the Massachusetts plan, last week I talked to a woman who is married to an insurance broker there. Her family is currently uninsured because they can't afford to buy a policy and now they've gotten billed by the state as a penalty. Apparently the affordable policy Massachusetts started out with has quadrupled. We need single payer, universal coverage funded by taxes. If we can bail out Wall Street, we can bail out the families of health insurance brokers.

[sandnsea]

36. $200-800 drs appts

It's no wonder nobody can afford these premiums. It's gone completely out of control. It's gone from $80 just ten years ago, which was already crazy, to $200. And the credentials of the support staff keeps going down. They've got CNA's doing what RN's did when I was a kid. Our clinic doesn't even do their own lab work, so they can't use that as an excuse here. All the x-rays and other testing is done at the hospital. So I've got no idea why these doctors need to charge so friggin' much.

[Wizard777]

39. Non competition preventing devaluation of services.

Back in the 80's there so many people trying to get into medical schools. They were afraid it would produce and over abundance of doctors. That would spawn competition that drive down the value of the doctors services. So the Federal Government started paying some colleges to quit teaching medicine to preserve the value of their services by preventing competition. Also with the demand for doctors exceeding supply. The medical boards aren't as quick to revoke medical licenses for malpractice. A doctor that removed someones penis instead of their appendix might be better than no doctor at all. That drives up medical malpractice insurance for the entire industry. As far as i'm concerned for the federal government to pay schools to quit teaching medicine is perfidy. But if we make the federal government pay all medical bills. Medical school will begin in kindergarten. Class this is a band aid and you will be a doctor by the time you graduate high school. I'll admit the hyperbole. But they'll try to get it as close to that as humanly possible.

[Wizard777]

40. They also allow billing fraud like "emergency services."

emergency services is determined by what they call the room they make you wait for services in. Not the time they provide the services in. After waiting in an "emergency room" for two hours to see a doctor. They have not provided emergency services. They have provided medical services. But not emergency medical servives. Yet they will still bill you for emergency medical services. We need to place time limits on what a hospital can call and bill as emergency services. We also need 24 hour clinics. But that will keep people from going to emergency rooms. That will reduce ER income. You might pay 40.00 - 80.00 at a 24 hour clinic. But you'll pay 360.00 for the same service in an emergency room.

[sandnsea]

41. No, no, this is regular office hours

Regular doctor visits. 5 - 10 routine visit, $200.00. Specialist $500+. No money, no insurance? No visit.

And this in Oregon where we are supposed to have a system that keeps costs down in order to make the Oregon Health Plan workable.

[Wizard777]

42. Then See: Non competition preventing devaluation of services.

The post you answered was just another cost increasing addendum to that.

The other big cost increaser is the insurance industry. They'll pay a hospital 20.00 for an asprin if that insures you can't afford to buy that asprin and buy their insurance instead. I think much of medical costs are artifically inflated by deals with Insurance Companies.

[jtrockville]

11. Sounds like Baucus wants to overhaul health INSURANCE, not care.

[kath]

13. that's right - and we need to keep pointing out the difference. We need universal health CARE, not

insurance.

[bemildred]

16. How about a mandate to kick these selfish weasels out of Congress?

Let's elect someone that wants to serve the public instead of themselves and their cronies.

[RedEarth]

18. Senator Takes Initiative on Health Care ( Paul Krugman: Hopeful signs on health care)

Source: NYT

Without waiting for President-elect Barack Obama, Senator Max Baucus, the chairman of the Finance Committee, will unveil a detailed blueprint on Wednesday to guarantee health insurance for all Americans by facilitating sales of private insurance, expanding Medicaid and Medicare, and requiring most employers to provide or pay for health benefits.

Aides to Mr. Obama said they welcomed the Congressional efforts, had encouraged Congress to take the lead and still considered health care a top priority, despite the urgent need to address huge problems afflicting the economy.

The plan proposed by Mr. Baucus, Democrat of Montana, would eventually require everyone to have health insurance coverage, with federal subsidies for those who could not otherwise afford it.

Other Democrats with deep experience in health care are also drafting proposals to expand coverage and slow the growth of health costs. These lawmakers include Senator Edward M. Kennedy of Massachusetts and Representatives John D. Dingell of Michigan and Pete Stark of California.


“Every American has a right to affordable, high-quality health care,” Mr. Baucus said. “Americans cannot wait any longer.” Far from being a distraction from efforts to revive the economy, he said, “health reform is an essential part of restoring America’s economy and maintaining our competitiveness.”



Read more: http://www.nytimes.com/2008/11/12/washington/12health.html?_r=2&oref=slogin&pagewanted=print

---

Paul Krugman

Hopeful signs on health care

This is very big news. One of the key questions about the new Democratic majority was whether Congress would try to play it safe, backing down on big ideas about reform, especially on health care. You can view the whole chorus about how we’re still a “center-right nation” as an attempt by the usual suspects to scare Democrats into scaling back their ambitions.

But now Max Baucus — Max Baucus! — is leading the charge on a health care plan that, at least at first read, is more like Hillary Clinton’s than Barack Obama’s; that is, it looks like an attempt at full universality. (The word I hear, by the way, is that Obama’s opposition to mandates was tactical politics, not conviction — so he may well be prepared to do the right thing now that the election is won.)

So this looks very good for the reformers. There’s now a reasonable chance that universal health care will be enacted next year!

http://krugman.blogs.nytimes.com/2008/11/12/hopeful-signs-on-health-care/

[riverwalker]

19. my hospital is laying off nurses

the first time in my 21 years there. Rumor is the other hospitals in the area are also going to lay off. I wonder if hospitals can start to collapse much like the banks.

[demodonkey]

44. Probably the CEO needs another bonus so cut the nurses & those left can do double shifts.

:puke:

[gateley]

20. Encouraging -- thanks! nt

[Bette Noir]

21. No exclusions for pre-existing conditions?

Nowadays, even hay fever is enough to make someone uninsurable on the open market.

I hope this is real.

[DollyM]

22. This can't come soon enough!

We have been covered under the Illinois All Kids/All Family program for the past several months as our jobs have came and gone. My husband is a diabetic and and can't get private insurance and has not been able to find steady enough work to cover him for insurance. Now we are scared to death because Illinois is apparently stopping the All Family program and not paying any of the medicaid bills! So we don't know if the Doctors my husband sees will even see him now. He just got out of the hospital for the second time this month and we don't know if those bills are going to be paid either. We needed this health care issue resolved years ago in our country. Now it is at crisis level when health care providers don't even know if they are going to get paid.

[Javaman]

23. One question...

is he pushing healthcare "insurance"? Or universal healthcare?

very big difference.

[nodehopper]

38. universal healthcare insurance CAN be tantamount to universal care

if it is accessible to everyone and heavily regulated.

I live in the Netherlands now, where health insurance is mandated. The industry is privatized, but very heavily regulated--there are 4 companies in the nation that offer plans. The regulations about how much they are allowed to charge and what they are required to cover are so strict that the plans are basically the same with some difference in practical details (i.e. which health clubs you can get discounts at or who you can order eyeglasses from). They cannot deny basic insurance (which covers everything non-elective) to anyone, there is no such thing as preexisting conditions, copays are minimal and pretty much exist only for dental work and non-prescribed physical therapy/massages/etc., and so forth and so on. The price difference between a group plan through work and an individual plan for people who are not working is less than 10 EU/month. But people who are unemployed or who are low-income get the insurance subsidized anyway. Basically everyone has the same health insurance that they can afford, that no one will ever deny them or cancel on them. So I think universal health insurance can work with heavy regulation...which, of course, would be a hard fight in the US.

[DU GrovelBot]

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