Thursday, September 17, 2009

Grading the Baucus Bill

Senator Max Baucus' much-maligned bill has been debuted, and there's no shortage of criticism on it. I'll be grading his bill, comparing it to the details set out by Obama in his health care speech.

*Do not scrap the current health care system. Examine and revise.
This is done easy enough. Baucus does not propose a major dismantling of the current health care system. Grade: A+

*Those already covered must not be forced to switch coverage or change doctors
It seems like Baucus' bill leaves those satisfied with their insurance or doctors well enough alone. Grade: A+

*Denying coverage due to preexisting conditions must be prohibited by law
The bill expressly prohibits the denial of coverage due to preexisting conditions. Simple enough. Grade: A+

*Coverage may not be dropped or diluted if the policy holder becomes ill
Not sure if there are prohibitions against this in the bill. I wager it is in there somewhere. Grade: Incomplete

*Arbitrary coverage caps for a year or lifetime will not be allowed
It appears that these are prohibited in the bill. Grade: A+

*Out-of-pocket expenses must be limited
It seems like there are limits in place, but they are higher than other plans we see. Grade: C-

*Routine checkups and preventive care must be covered with no additional cost
This seems to be one of the major strengths of the Baucus bill. It makes it far cheaper to receive preventive care and check-ups, and also works to reward healthy lifestyle choices, particularly for Medicare and Medicaid enrollees. But it doesn't do much for those outside those programs. Grade: B+

*Individuals and small businesses may purchase insurance through a market
Yes, there is a market created in the Baucus bill for this purpose. Grade: A+

*Those who cannot afford insurance will be provided with tax credits based upon need
There are subsidies for those who cannot afford insurance, but they are smaller than everything else proposed. While this does keep the overall cost down, it does little good if people still can't buy insurance even with tax credits. Grade: C

*Insurance companies desiring to participate in the aforementioned market have four years to adhere to the outlined regulations above
Yes, the deadline is in 2013. Grade: A+

*Those currently uninsured due to preexisting conditions will be offered low-cost coverage immediately in case of catastrophic illness
There is a catastrophic-only option offered, but only available for the "young invincible" (yes, that is a phrase in the bill). I'm not sure if the plan makes immediate coverage available to those currently uninsured. Grade: C/Incomplete

*Health insurance will be mandatory
Yes, it is mandatory. But the costs for not getting insurance are very high. Combine this with low tax credits, and you may end up with a lot of poor people who still can't buy insurance or afford the four-figure fines associated with that. Grade: C-

*Businesses must offer health care or chip in to cover the costs of health care
This is included in the bill, but there are no regulations of the quality of the care provided. Larger companies could offer expensive programs with low benefits at their leisure, and most workers would be forced to take it. Regulations are necessary. Grade: C+

*There will be a hardship waiver, applicable to 95% of all small businesses
The bill makes it very easy for most small businesses to be waived from their requirements. Grade: A+

*A public option will be made available, running as a not-for profit
There is no public option, instead going for the co-op method. The government will provide start up and solvency funds. Co-ops will be not-for-profit, and any leftover funds they do have will be used to lower premiums or improve benefits. Co-ops will be state-by-state. This is difficult, especially if a state elects not to establish a co-op. It would be far simpler to create a national public option. Grade: B

*This public option will only be available to those who currently do not have insurance
Co-ops are a different beast, but they only seem to be available to those without insurance. Grade: C

*The public option must be self-sufficient
The co-ops will have start-up funds provided, but they are otherwise self-sufficient. Grade: A+

*The overall plan must be deficit neutral
This plan attempts to be deficit neutral, but the way its finances are organized, it's highly doubtful. Grade: C-

*Establish some method of malpractice reform
Since malpractice is mostly covered at the state levels, the bill does not explicitly implement reform. It does, however, call for states to examine their system to seek alternatives to the current litigation system. Whether states do so or not is not mandated. Grade: C+

*The cost must be limited to $900 billion over 10 years
Definitely passes. At $856 billion, it's the lowest figure seen among any of the health care proposals. Grade: A-

*Slow the growth of health care costs by 1/10 of 1% per year
It's hard to see this plan control costs without a public option, and the bill has no regulations to even attempt to control the costs of care. This bill will likely not control costs in any way. Grade: F

*If savings are not up to expectations, create spending cuts
Not sure if this is included. Baucus seems to be trying to put the cart before the horse by keeping the initial cost of his bill low. It would be wiser to start at a higher cost, then reduce it year by year as we know the costs decrease, rather than start low and have to keep increasing because we find that the first year costs are more than expected. Grade: C+

*Meet the following goals:
*Provide security and stability for those with insurance
*Provide insurance for those who currently have none
*Slow the growth of costs

The big grade. Baucus clearly is reaching for compromise in his bill, but the fact that no Republicans have voiced favor for the bill tells me that something isn't quite right. Overall, the bill doesn't really achieve goals 2 or 3 very well, which are the two goals that are the most important. It's very easy to accomplish goal 1; simply create regulations that prohibit the dropping of coverage or care. But Baucus' bill could do more to make insurance available for those without it, and it certainly doesn't slow the growth of costs. Instead, it tries to keep its own costs down, perhaps at the cost of effectiveness. OVERALL GRADE: B/B-

Thursday, September 10, 2009

The Health Care Speech

Continued posting of the bill is on hiatus. First, a lack of time. Second, the very real possibility that everything may begin to change after last night's speech.

Regarding last night's speech:

In baseball parlance, I'd give it a triple with bases loaded. Not exactly a grand slam home run, but a very effective play. Included some details, but you have to remember: Obama is clearly a president who believes that Congress should legislate. He'll lay down some ground rules, but will defer to the legislature when the precise terms are written. This is a clear difference from the Bush administration, which had a habit of legislating from the executive's office. So here's the ground rules of health care reform:

*Do not scrap the current health care system. Examine and revise.
*Meet the following goals:
*Provide security and stability for those with insurance
*Provide insurance for those who currently have none
*Slow the growth of costs
*Those already covered must not be forced to switch coverage or change doctors
*Denying coverage due to preexisting conditions must be prohibited by law
*Coverage may not be dropped or diluted if the policy holder becomes ill
*Arbitrary coverage caps for a year or lifetime will not be allowed
*Out-of-pocket expenses must be limited
*Routine checkups and preventive care must be covered with no additional cost
*Individuals and small businesses may purchase insurance through a market
*Those who cannot afford insurance will be provided with tax credits based upon need
*Insurance companies desiring to participate in the aforementioned market have four years to adhere to the outlined regulations above
*Those currently uninsured due to preexisting conditions will be offered low-cost coverage immediately in case of catastrophic illness
*Health insurance will be mandatory
*Businesses must offer health care or chip in to cover the costs of health care
*There will be a hardship waiver, applicable to 95% of all small businesses
*A public option will be made available, running as a not-for profit
*This public option will only be available to those who currently do not have insurance
*The public option must be self-sufficient
*The overall plan must be deficit neutral
*Establish some method of malpractice reform
*The cost must be limited to $900 billion over 10 years
*Slow the growth of health care costs by 1/10 of 1% per year
*If savings are not up to expectations, create spending cuts

Overall, I see a lot of stuff from HR 3200 in here. That may form a foundation for a unified health care bill. Given these parameters, how would you establish a reformed health care system?