As featured on p. 218 of "Bloggers on the Bus," under the name "a MyDD blogger."

Monday, July 27, 2009

Mad Max

Sen. Baucus emerges from the bipartisan crypt and comes up with a health care bill that cannot possibly work.

After weeks of secretive talks, a bipartisan group in the Senate edged closer Monday to a health care compromise that omits a requirement for businesses to offer coverage to their workers and lacks a government insurance option that President Barack Obama favors, according to numerous officials.

Like bills drafted by Democrats, the proposal under discussion by six members on the Senate Finance Committee would bar insurance companies from denying coverage to any applicant. Nor could insurers charge higher premiums on the basis of pre-existing medical conditions.

But it jettisons other core Democratic provisions in a reach for bipartisanship on an issue that has so far produced little.

Amusingly, at this moment the Chamber of Commerce and PhRMA jumped in to call for passage of health care reform. Probably because this bill wouldn't touch their profits or do anything for the consumer.

We expected Baucus' bill to have co-ops substituted for the public option. It's one of the three bills out there, and was always going to be the worst. But they jettisoned the employer mandate, taking the "shared" out of the shared responsibility that most reform bills have offered. Even WAL-MART supports an employer mandate. They did include the MedPAC proposal and the excise tax on insurance companies offering expensive plans and even a potential fee on medical device manufacturers and drugmakers.

This is precisely the kind of proposal you would expect from Baucus, some Republicans, and the head budget guy in Congress sitting in the room:

They have met for hours in recent weeks in Baucus' office, joined by aides and outside advisers such as actuaries summoned to explain arcane details of insurance. Douglas Elmendorf, head of the Congressional Budget Office, has also attended.

It's all driven by costs and not people, so the coverage subsidies are lower (300% FPL). And yet, the money that would be gained from an employer mandate is foregone because Baucus doesn't want to upset corporations. The money that would be saved from a robust public option is foregone because he doesn't want to upset the insurance companies. As long as the arbitrary $1 trillion dollar number is reached and the special interests made happy, Baucus can live with a forced mandate to the people to buy unaffordable insurance with crappy benefits without the choice of a government-run option. And of course, we're not even coming close to talking about the kinds of real savings that would come with health industry providers accepting less in reimbursement payments. Nor are we talking about radical change to achieve savings, like ditching the fee-for-service model.

Even when doctors order costly treatments with serious side effects and little evidence of their being effective, as studies find is common, patients are loath to question the decision. Instead of blaming such treatments for the rising cost of medicine, many people are inclined to blame forces that health economists say are far less important, like greedy insurance companies or onerous malpractice laws [...]

Medicare data shows that (the Mayo Clinic and the Cleveland Clinic) generally provide less expensive care and appear to deliver better results. Armed with this data, the doctors who run the groups have been lobbying Congress to make their model a bigger part of health reform. Two weeks ago, 13 such groups released a letter saying that recent versions of proposed legislation did not control costs enough.

Their goal is to weaken the fee-for-service system. In its place, doctors might receive a lump-sum payment to treat a patient with a certain condition, based on average costs elsewhere and on what scientific evidence had found to be effective. Hospitals with especially good outcomes might earn bonuses.

Advocates say such a system could ultimately give doctors more control. Rather than having to organize their schedules around the tests and procedures that insurers agree to reimburse, doctors could opt for the treatments they deem most effective. “It’s a lot more accountability, which is why it’s scary for physicians,” said Dr. Mark McClellan, a former head of Medicare under George W. Bush. “But in some ways it’s also more autonomy.”

If Max Baucus and his compatriots were intellectually honest about controlling costs, they would offer this. Instead, he neglects elements that would cut costs, unless they have to do with restricting access and making ordinary Americans suffer, in which case he enacts them gladly.

I hope that, once this bill is out of Baucus' hands, that we can understand he doesn't run national health care policy. The Senate can actually vote for better alternatives if they choose.

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