A Bad Compromise

You might've awoke to the news that the Congressional Budget Office (CBO) has checked Max Baucus's healthcare reform bill and found it awesome -- at least, in budgetary terms. The Hill is reporting that the "bill took a giant step forward Wednesday as congressional scorekeepers concluded that it would extend coverage to millions of Americans while also cutting the deficit." It leaves 20 million uninsured, but who cares? It doesn't dent the deficit and that's what really matters.

Of course, over at the right wing National Review, Tevi Troy puts a lot of effort into showing why the CBO's numbers are hiding the awful truth; we'll be taxed to death, Medicare will be shot out of a cannon into the sun, and illegal immigrants won't be covered (I thought the right was against covering undocumented people. They were yesterday, anyway). To his credit, Troy doesn't mention death panels, ACORN, or FEMA camps once. I guess he's more focused than average.

The only problem with all this "Yay (or boo) for Max Baucus and the CBO!" reporting is that this whole thing is missing one crucial element -- an actual bill.


[William A. Jacobson, Le*gal In*sur*rec*tion:]

The internet is alive with the sound of people analyzing the CBO's "scoring" of the Max Baucus aka Senate Finance Committee Health Care Bill. Before everyone gets too deeply into their thoughts, please keep in mind the following (get ready, all CAPS, bold... signifies a really important concept):

THERE IS NO BAUCUS BILL.

The CBO scored the concepts described by the Baucus Committee. There is no legislative text. None. Baucus and his Democratic colleagues refused to reduce their concepts to actual legislation prior to a vote. Here is the CBO's disclaimer:

"CBO and JCT's analysis is preliminary in large part because the Chairman's mark, as amended, has not yet been embodied in legislative language."

The Baucus Concepts are disasterous, but that's for another post. For this post, let me get across a simple concept: THERE IS NO BAUCUS BILL.

I think the point he's trying to get across here is that there is no Baucus bill. The subtlety may make it hard to understand that point.

Jacobson's a little farther to the right than most people I usually quote, but his point is valid; we need to stop talking about whatever bill is in committee at the moment as the bill. To Williams' great distress, the Finance Committee non-bill is the only bill out of any committee in either chamber of congress that doesn't include a public option. Fully 80% of all proposed or written legislative language includes a public health insurance option in some form. And the fight to get it included in the Finance Committee's bill is not over.

But that doesn't mean it's taking a turn for the better, either. Sam Stein at Huffington Post reports that a compromise is being considered that many think is the answer.


Senate Democrats have begun discussions on a compromise approach to health care reform that would establish a robust, national public option for insurance coverage but give individual states the right to opt out of the program.

The proposal is envisioned as a means of getting the necessary support from progressive members of the Democratic Caucus -- who have insisted that a government-run insurance option remain in the bill -- and conservative Democrats who are worried about what a public plan would mean for insurers in their states.

"What folks are looking for is what gets 60 votes," said a senior Democratic Hill aide. "The opt-out idea is very appealing to people. It has come up in conversations. I know personally that a handful of members have discussed it amongst themselves."


The first thing that's going to pop into a lot of people's heads here is that this would screw people in states where the government is certifiable -- e.g., Texas, Alaska, South Carolina, etc. Number two is probably imagining a dysfuctional congress passing the buck to their own dysfunctional state legislatures.

Neither of these are especially great prospects, but what should really be worrying you is that this would undermine the whole purpose of a public option -- competition. What we'd wind up with would be major insurers engaging in a race to the bottom, trying to suck the most money out of the states with the stupidest laws. By a weird coincidence, this is already part of the problem. If the drain on our economy comes only from red states, it's hardly an improvement -- you only need one drain to get all the water out of your tub.

Still, this is a better idea than the alternatives, as Stein goes on to report:


In conversations with the Huffington Post, sources have said that while the opt-out approach to the public plan is in its nascent stages it has been discussed with leadership in the Senate. It was pulled out of an alternative idea, put forth by Sen. Tom Carper (D-Del.) and, prior to him, former Senate Majority Leader Tom Daschle, to give states the power to determine whether they want to implement a public insurance option.

But instead of starting with no national public option and giving state governments the right to develop their own, the newest compromise approaches the issue from the opposite direction: beginning with a national public option and giving state governments the right not to have one.


Still, a bad idea is a bad idea. The only upside I can see to this is that it would be harder to justify not going with the option; advocates could argue that their state legislatures were trying to make the option illegal. It's a political and messaging advantage, rather than a practical one, but it's there nonetheless.

But even if this is the way the Finance Committee goes, it won't be the bill. It'll just be an idea for a bill submitted by the committee. And the good news here is that this would put some form of a public option in 100% of all healthcare legislation coming out of congress. And this mechanism would have to survive two hurdles; first in being joined with the much better bill out of the Senate Committee on Health, Education, Labor, and Pensions (the HELP Committee bill), then in being joined with the final House bill. I hate making predictions, but I just don't see that happening.

I guess if there's one thing I want you to take away from this post, it's that the news of the birth of Max Baucus' bill has been greatly exaggerated. There is no Baucus bill and Baucus's eventual bill won't be the bill. This whole thing is going to roll on for a while.

Already sick of it? Join the club. Now imagine it starting all over in every state in the union.

-Wisco


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