Baucus Coughs Up a Bill

Big news broke over the weekend: Evidently, the president lit a fire under Max Baucus (D-Mont) and the Senate Finance Committee by unexpectedly announcing last week that he’d be laying out his own vision for health care reform this Wednesday. Just weeks ago, committee member Kent Conrad (D-ND) predicted the Finance Committee wouldn’t have a bill until November. But Baucus circulated a legislative framework over the weekend.

Baucus’s bottom line: There will be no public option. Instead, the government will spend hundreds of billions of dollars to subsidize the same old expensive, inadequate private insurance system that health care reform was supposed to reform. The insurance companies get 46 million new customers, and in return, they will pay higher taxes to offset the cost of the subsidies—a kickback to Uncle Sam.

Last week Brian Beutler of Talking Points Memo and I sat down to discuss some burning questions in health care reform: What’s the president’s thinking on the public option? What leverage does he have over the progressives in the House who demand single payer and/or the Blue Dogs in the senate who reject it? Why is Sen. Olympia Snowe (R-Maine) the last best hope for bipartisanship? (The transcript of our discussion has been edited for brevity and clarity.)

You said the [week of September 1] really stood out from the last month in terms of the health care debate. How so?

Maybe the last two days just stood out from the previous month. … Obama’s approval [rating] slid and popular support for the idea of healthcare reform slid. And August came to an end and the President’s vacation is winding down, and suddenly the administration realizes that Congress is coming back and they are going to have to do something. And so, it seems they start leaking to a bunch of high profile reporters that they are going to perhaps ditch the public option as part of a grander move to regain control of the debate.

Are the anonymous leakers saying in so many words that they want to ditch the public option?

Well, it’s unclear what they are actually going to do. The Public Option would die with dignity. [If] that is accomplished, the President could maybe win over some Republicans, grab the debate and spell out in clearer terms what he wanted [beyond] the public option. He could do this all in a big speech for Congress which is scheduled to happen Wednesday.

Isn’t this just a repeat of what we saw during the week of August 20, when the White House seemed to be doing a good cop/bad cop routine where an anonymous aide would leak “to hell with the liberals and the public option” and then another adviser would say on the record how much the president loves the public option?

It could just be a replay. Once those stories came out, the picture sort of fogged up. [There were] secondary reports that the President was courting Olympia Snowe (R-Maine) again—as if maybe one Senate Republican would vote with him on health care reform. Snowe’s idea [includes a] public option, but you attach it to a trigger mechanism so that it is only enacted if the rest of healthcare reform is unsuccessful at bringing down prices and expanding coverage. And that’s sort of been unacceptable to reformers and progressives, but … that might be the pound of flesh that she yields from the bill. It fits in with the picture that the leakers painted … that the public option was no longer going to be one of the key features of the bill.

You wrote about how budget reconciliation could be used to get around the filibuster. How would that work?

The greater problem is the structure in the Senate, where legislation can pass with a majority vote—but only after Senators have debated the bill for as long as they want. As long as 60 Democrats aren’t there to shut the minority up, debate can go on and on and on. [ED note: AKA filibustering.] And for every major piece of legislation you see. this happens. …

There’s this de facto 60-vote rule on most legislation, at least in this Congress and the previous Congress since the Democrats took it over. It’s extremely difficult to pass a bill through just the regular procedure without either having to concede a bunch of substantive provisions … or just give up on the bill entirely. [There are] 59 members of the Democratic caucus right now, and maybe 10 of them are mushy on the more progressive part of the President’s agenda. Even if all of them are onboard, you’re still one vote short of what you need to end debate. And that is why Olympia Snowe matters right now.

So the House would pass the bill and the Senate would pass a bill with budget reconciliation?

They could in theory. Budget reconciliation is sort of like a magic bullet. Every year, the Congress can pass what is known as a budget reconciliation bill. It sets new taxes, or moves money around within the federal budget to basically do what the Congress’s budget lays out. It … was made exempt from the filibuster because Congress [has to] set a budget. … They need to make sure that money is there and can’t have Senators filibustering it just because they’re in a fit of peak. So that bill can’t be filibustered, but at the same time, the legislation that can be passed in it has to be relevant to the budget, it has to move money around in some way.

So you can pass a lot of elements of healthcare reform in theory—you can pass subsidies to poor people and middle-income people. And you can pass Medicaid expansion, and you might even be able to pass the public option because the public option may need subsidies of its own and could drive down other costs and be a big moneysaver.

How might the president pressure progressives into accepting the bill?

My sense is that the President [will pressure] progressives to back off on the public option. But that could change. Trying to figure out what is going to happen is kind of like trying to move 23,000 moves ahead in a game of 17 dimensional chess. …

[Obama can] say is that what he’s planning will, while not perfect, help a lot of people make the healthcare system more progressive than it was. … But it would really harm the democratic party and his presidency if the whole project failed and nothing passed. Obama doesn’t have a tremendous amount of leverage. [Many] progressive members of Congress are progressive because they don’t have viable challenges. They come from progressive districts, with constituents like them, approval ratings in the 60s, 70s, and they aren’t going to lose to a member of the opposite party. So in that sense, they can do what they want.

How can Blue Dogs say that progressives should suck it up and vote for every bill when they are never prepared to do the same thing?

… It would at least be a good experiment, for the party and the country, for the [Blue Dogs] to be put on the spot. They believe that their jobs are on the line if they vote for controversial legislation. I don’t know how those conversations go when political members of the administration confront these guys and say ‘You got into politics to make the world a better place, not to just have a tenure job on Capital Hill. So you’re going to vote yes on this and if you lose your jobs as a result, then you did the right thing and we’ll make sure that the Democratic party infrastructure is there for you … .’ But that’s not the way the party thinks. [It's a] game of building an unstoppably large coalition, and that becomes the goal in the end. And at some point you lose sight of why you are amassing this giant congressional majority and you’re never willing to say, well we built this 70 whatever majority so that we could sacrifice some of these seats and do something really impressive and progressive for the good of the country.

This post features links to the best independent, progressive reporting about health care and is free to reprint. This is a project of The Media Consortium, a network of 50 leading independent media outlets.

Senator Max Baucus' media website
By Lindsay Beyerstein

Disclaimer: The views expressed above are solely those of the author and may not reflect those of
Care2, Inc., its employees or advertisers.

jamilah s.

7:03AM PDT on Sep 11, 2009

James R. Stewart Jr is right. In my opinion, this is not a political issue even though this is politics, it is a moral issue. How many people will we watch die b ecause they do nothave health coverage. This is America! Poorer countries provide better health coverage than us with all of our means.

There really shouldnot be a debate. I am just glad we have someone who isgoing to bat for us without wavering!

send a green star

Tim S.

6:43PM PDT on Sep 9, 2009

For decades I have re- voted Max to office... looks like I will have to find one of those 'AX MAX' bumper stickers cuzz he is bought and paid for!!

Helen T.

2:09PM PDT on Sep 9, 2009

Unfortunately, as a Montana resident I hold my nose and vote for this douche every six years, because the alternative candidate is invariably worse. But he might as well stick an "R" after his name, with the way he votes. Even so, the Republicans in our state STILL wouldn't vote for him. "AX MAX" stickers have been common for decades.

Ronald N.

2:02PM PDT on Sep 9, 2009

It's no secret. The private sector is afraid of a single payer or even a public option system. If there is any compromise, it will be a meager one for the public. I propose we go single payer without compromise. But it's one of those things money, power and the industry has in it's favor. They will fight despite what anyone thinks. The cause is to continue the status quo of our health system. I fear without mandates and power by the public, any option won't work. Without cooperation from the private sector of the health insurance, big pharma, hospital complex, there will be a bleak outcome. First and formost, corporations control government and the people aren't being represented, maybe except for a handful of representatives. Those who can't see this corruption having been paying much attention.

Senator Baucus, is the worst of the worst. Don't look for anythig that will help the public.

Past Member .

11:45AM PDT on Sep 9, 2009

Yeah Donna!!!! Agreed on tort reform; it protects corporate profits and reduces our rights. Meanwhile companies keep charging what the market will bear. When will Reps/Cons, who scream that capitalism/free markets are the end-all, begin to understand the most basic aspects of market forces / dynamics?

Whew!

Also ...

+1 Mary B!

Jim D (now Fred since they whacked my Jim D profile)

Mary B.

11:01AM PDT on Sep 9, 2009

We must have Single Payer. Simple, straight foreward, very doable and implimented once the booga booga 'oh it's socialism' dopys are out of the way.
We also need a Public Option for those who are so endoctrinated to believe 'insurence' means 'health care'.
And for the moneied people they can still have their premium Insurence coverage.
Does everybody get this now? Nobody is forced to give up what they have. But those who presently have nothing will be covered.
And considering the present population of our country, the amount of infrastructure needed and the cost of modern tecnology, don't expect the 'size of government' to shrink any time soon. So just drop that argument. Unfortunatly, so many people on the Right sound like they just woke up from the early 1900's, and the Civil War and Revolutionary War days and are just bathering off old ideas and notions that may have been appropriate then, but have nothing to do with present reality.

Jean A.

9:45AM PDT on Sep 9, 2009

Skip what is wrong with Hospice? There are two, one non-profit and one for profit. Eliminate the for profit. I am so afraid the health care program will disappoint the American people. We need to kick the Senators out of office. I will not vote for one incumbant anymore. They are all slippery and corrupt. This decision will hurt them if they don't include a public option. Stick to your guns and scream at your senators.

James R. S.

9:40AM PDT on Sep 9, 2009

Ladies and Gentlemen: I have said this here twice before, and I must say it Again: I am 76 years old. Ten years ago, my company raised my medical insurance premiums from $90. a week to $100. a week. I Can't Afford That Much. Now I am retired, and on Social Security. I NEED MEDICARE. HUNDREDS OF THOUSANDS OF US SENIORS DO. AND ALSO SIMILAR NUMBERS OF YOUNGER PEOPLE AS WELL.
If you want to have private insurance, It Is Still A Free Country.
Pay The Premiums, And Get Your Private Insurance. The Public Option Is Just That. IT IS OPTIONAL. NOBODY HAS TO CHOSE IT. BUT: THOSE OF US WHO NEED IT MUST HAVE THE RIGHT TO CHOOSE IT. OTHERWISE, WE GO BANKRUPT. AND VERY LIKELY A GREAT MANY OF US WILL
DIE FOR LACK OF MEDICAL CARE. DEAD. WHAT DO YOU WANT? IT IS NOT JUST A POLITICAL QUESTION !!! IT IS ABOUT OUR PHYSICAL SURVIVAL. GOOD GRIEF. HELP.

Donna C.

9:30AM PDT on Sep 9, 2009

1. Tort reform has been done in 27 states. The strongest reform was done in Texas. Texas health care costs have not come down at all; in fact they are among the highest in the nation. Tort Reform has not reduced costs in any of the states that have done it.

2. Interstate choice is already in the proposed House Bill.

3. Your "patient abuse" is someone else's "need". Who decides what abuse is? Isn't that the famous "death panel" stuff?

4. Reducing drugs costs is already in the proposed House Bill.

5. Medicaid and Medicare to Private Insurance Consortium...surely you can't be serious! We should let the insurance industry make more money?

6. Equalizing Physician payments is already part of the current bill and one of it's objectives is to encourage more doctors to go into General Practice.

7. Stopping the Medicare Advantage "platinum plans" is already a part of the current House Bill.

8. The Nursing Home Industries certainly needs supervision and quality/cost control. However, Hospice is one of the most cost effective programs we have and is not nursing home care. Hospice is a voluntary and takes place in the patient's home and is far less costly than end of life hospitalization. I am not sure what you're problem is with Hospice.

9. I don't know how we would eliminate profit-seeking investors. Who would invest anywhere if they weren't going to make a profit? ...oh wait, "not for profit heathcare for all"....what a concept.

Lee H.

8:54AM PDT on Sep 9, 2009

Without the public option, insurance reform is not going to happen. The only thing that moves the profiteers is sheer force of numbers. When people have a choice between Medicare and for profit insurance, the companies will see their enrollees numbers drop, and that is the only thing that will force them to change their greedy ways.

Unfortunately, there many on the right who are willing to forgo their own benefit from reform to help the greedsters. They simply put ideology before reality. Or, in other words - cutting off the nose to spite their face.