The lead editorial in the New York Times today neatly sums up what health non-profits, informed patients and consumer advocates are seeking in health care reform, a "public option" to provide a sort of free-market alternative to the unbeloved private insurance companies. Yet at the same time, the Senate's lead developer on health reform, Sen. Max Baucus, is demanding more "compromise" with opponents of that public option (see below). Who's reflecting what Americans need?
The editorial said:
President Obama has rightly called for sweeping health care reform
and charged Congress with coming up with a program. Expect a tough
Already one of the most contentious issues is whether to include a
new public plan option to compete with private insurance plans. Many
Republicans deride it as “government-run health care” and a step toward
“socialized medicine.” Democrats find the notion appealing — even of
A new public plan — to offer consumers greater choice, keep the
private plans honest and, one can hope, restrain the relentless growth
in health care premiums and underlying medical costs — seems worth
What many critics seem to fear most is that a new public plan would
sweep away its private competitors and evolve over time into a
full-fledged single-payer system (sometimes called Medicare for all).
No matter how fair the competition between public and private plans
might be at the start, they warn that the government would find it
irresistible to rig the outcome through its regulatory and pricing
powers and its ability, in a pinch, to subsidize the public plan with
That fear seems overblown. Innovative, nimble private plans with
well-integrated service systems might outperform any government plan,
just as some now outperform Medicare through better coordination of
services, stronger preventive care and broader benefits.
A new public plan is neither the cornerstone of health care reform
nor the death knell of private insurance. It should be tried as one
element of comprehensive reform. If, over time, a vast majority decides
the government plan is superior, so be it.
Concise, to the point. Let Americans choose.
Yet in a hearing yesterday on the Congressional budget plan, we heard this from Baucus (D-Montana) (via the subsciption-only Congressional quarterly):
“We want health care reform to be sustainable, and that means getting a significant number of Republicans on board.” If they are on board it is sustainable. Otherwise it’s partisan, it’s less sustainable, we’re back in the soup again, we’re fighting. Americans don’t want that.”
Sounds moderate and reasonable, until you dig just a little. Baucus chairs the Senate Finance Committee, whose senior Republican is Charles Grassley of of Iowa. Grassley, who speaks for the whole minority party on health reform, has called any choice of a public health care option a "deal breaker." Baucus consistently goes out of his way to cooperate with Grassley, who is channeling the position of U.S. health insurers. And Baucus himself is one of the top recipients in Congress of contributions from health insurance and pharmaceutical companies -- $412,000 over the last two federal election cycles.
It's reasonable to wonder why Big Healthcare would lavish so much money on Baucus. Montana is no hotbed of insurance or pharmaceutical activity. Baucus won his 2008 election race 73 percent to 27 percent over an 85-year-old Republican lawyer.
More than 90 percent of Baucus' campaign contributions come from out of state. Can you say "Finance Committee chairman"? Baucus also backed a provision of the 2003 Medicare prescription drug coverage law that handed over the whole operation to private companies and forbade Medicare from bargaining with drug companies for better prices.
So with Baucus in charge, and listening so respectfully to Sen. Grassley, we can all wonder whether public opinion and impeccable reasoning, as in the editorial, have a chance against the power of the insurance and pharmaceutical industries. It's up to Baucus now to prove that he's hearing more than the lobbyist chorus, and willing to "get into the soup and fight" on behalf of health care reform that's more than a customer delivery system for insurance companies.