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A Senate health care reform "policy options" document released last night gives us a good idea where national reform plans will go, and it offers some major causes for worry. It states without reservation that  every American must show proof of insurance coverage, with a few exceptions. And a strong "public option," like voluntary Medicare, is just one of several possibilities. Before we get to the laudable parts, Consumer Watchdog wants to state one thing clearly: If federal health reforms demand that Americans buy unregulated private insurance, and don't offer a public option of Medicare strength, it will be a criminal ripoff of families and taxpayers.

By "unregulated," we mean without tough rate restrictions and other cost-reducing regulation. There is simply no way to keep comprehensive private insurance affordable for middle-class families (or for taxpayers, because of the subsidies) without a robust publicly administered plan in competition.

The paper also puts out an option in which employers would not have to help pay for employee insurance but employees would still be required to buy individual policies. That is as far as you can get from "shared responsibility," putting every thing on employees' backs, while letting employers off scot-free.

This is just our first pass through the 63-page document from the Senate Finance Comittee led by Sen. Max Baucus (D-Mont.). There will be more to say later. The document does have good expansions of Medicaid coverage for the very poor, and some form of subsidy for families up to 400 percent of the federal poverty level. It indicates there will be decent requirements for what has to be covered by every health plan. Overall, it looks a lot like the Massachusetts system, but likely to have more concessions to private, for-profit insurance companies.

For instance: In the Senate outline, older people could be charged up to five times as much as younger people for their insurance (In Massachusetts, the cap is twice as much). That's a large step away from having a "big pool" to share costs broadly.

And there is no mention of capping out of pocket costs to patients. This may just be an omission, but given the level of detail in the document, I don't know. Without a firm cap on yearly out lof pocket costs, families with a health crisis could still be forced into bankruptcy. And it indicates that insurance choices will be modeled on the Medicare drug prescription plan. Anyone who has helped a parent make those insanely complex choices will have a shiver up their spine.

Another point that may be covered later: There is nothing that I can see about curbing administrative waste and excess profit by insurance companies or containing other medical costs.  Without that, insurance rates will continue rising out of control, even though we'll be required to buy policies.

It is gratifying to have this policy paper issued for public scrutiny. We're at least not being presented with a take-it-or-leave-it deal, as happened in the Clinton administration. But the Senate committee will now take its deliberations private, while still subject to very heavy industry lobbying. That's not a condition likely to produce better proposals for consumers.