September 23, 2009 Leave a comment
Because I really like the Baucus bill and what is happening with it. What? Aren't liberals supposed to hate it? The Baucus bill falls woefully short on subsidies for people buying insurance, but the truth is that can be easily fixed, and I suspect will be. What I really like, is that the bill is making a big effort to institute all sorts of measures to control costs through more efficient medicine and payment policies. That's exactly what we need. We need fundamental reform that's going to curb our over-reliance on overly-costly fee-for-service medicine. The Baucus bill makes efforts on many fronts to do that. CBO director, Peter Orzag, a leading advocate of smart and efficient cost control policy is a big fan. He discusses it with Ezra here. Here he is on how it should drive down the cost of insurance:
How do the delivery-side reforms interact with the insurance market?
Several ways. Perhaps most immediately, your premiums will
ultimately be driven by the underlying cost of health care. To the
extent these reforms help to contain costs over time, they have a
significant influence in the insurance market through the level of
premiums. It’s also the case that Medicare can lead the private
insurance market in terms of moving towards a value-based system, and
we’ve seen that in past examples. In the ’80s, Medicare moved towards
fixed payments for each hospital stay, and that created an incentive
for hospitals to reduce the length of stays. The result was shortened
stays for everyone and not just Medicare patients. And many of the
changes floating around with regard to Medicare in this bill have
And, yes, I'd like to see a public option. But, a public option does no good if you are not allowed to participate in an insurance exchange, and the ability to participate in those exchanges in greatly limited in the House and HELP bills. Believe me, I want a different choice than BCBS North Carolina. The Baucus bill opens up the exchanges much wider (though after quite a few years) and it seems that he is amenable to Ron Wyden's Free Choice amendment that would enable much more widespread participation in health insurance exchanges earlier in the process. Ezra Klein has argued, and I'm inclined to agree, that this is much more important than whether we have what would essentially amount to a token public option available to only a few million Americans. Of course, I haven't discussed the politics of this at all, which still aren't exactly easy, but we seem to be moving in a direction towards having much more effective and efficient policy than I thought we had any chance of just a month ago. And I like good policy.