A Health Care Reform Compromise: Democrats Will Be Displeased

by Pejman Yousefzadeh on July 28, 2009

A group of six Senators are working on crafting a compromise health care reform plan that will leave out key Democratic provisions:

Bipartisan negotiations on the Senate Finance Committee are moving closer to eliminating two health care provisions favored by many Democrats – a mandate on employers to provide insurance or pay a penalty, and a government insurance option, a senator and health care insiders said Monday.

That could bring even greater pressure on Finance Chairman Max Baucus (D-Mont.), who has been challenged by more liberal senators who say he is sacrificing key Democratic priorities on health care reform to win the votes of a few Republicans.

Sen. Olympia Snowe (R-Maine) confirmed that the three Republicans and three Democrats negotiating the Senate Finance bill are moving away from a broad-based mandate that would force employers to offer insurance. The senators instead are leaning toward a “free rider” provision that requires employers to pay for employees who receive coverage through Medicaid or who receive new government subsidies to purchase insurance through an exchange.

Snowe stressed the committee hasn’t reached a final agreement on any of the key provisions but said, “There is not a broad-based employer mandate. … There are approximately 170 million Americans that receive coverage through employers. That is a significant percentage of the population. We don’t want to undermine that or create a perverse incentive where employers drop the coverage because their employees could potentially get subsidies through the exchange.”

On the nonprofit insurance cooperative, Snowe also said no final decisions have been reached, but “it is safe to say it is probably one that will remain in the final document.”

This is a huge deal. It demonstrates that there is a split in the Democratic Congressional coalition concerning the shape and nature of health care reform. If the White House goes against the group of six’s plan, it may infuriate the Chairman of the Senate Finance Committee, Max Baucus. If it endorses the plan, it will infuriate liberal Democrats who insist on a public option, and the mandate on employers to provide insurance.

I predict that within short order, the White House will join liberal Democrats to rain rhetorical fire down on the group of six, and denounce their plan. The thinking will likely be that with Democrats in charge of Congress, there should be no reason why a more liberal plan can’t eventually be passed. Of course, this requires Blue Dog cooperation to get the House plan out of the starting gate, but if the Administration and the Congressional leadership can’t get that cooperation, they may work on pushing either the Senate Finance Committee’s own plan (not to be confused with the group of six’s plan), or the Senate Health, Education, Labor, and Pensions (HELP) Committee plan. And if worst comes to worst, reconciliation may ultimately be used in order to push a plan through over Republican opposition in the Senate.

But that doesn’t reduce the significance of the group of six’s plan. It creates a more moderate reform plan for Senators and Representatives to support. It could allow Republicans to rally around a plan, instead of opposing everything. It may well split the Democratic coalition in Washington. And, absent the use of reconciliation to push through a more liberal bill, in any final negotiations, it may be used to bargain down or bargain away some of the provisions Democrats want most in any health care reform bill.

  • HSR0601

    A pay for outcome / value payment system, key to the deficit-neutral, might be capable of bringing all groups together.

    Supporters of the agreement say it could save the Medicare System more than $100 billion a year and 'improve' care, that means more than $1trillian over a decade, and virtually needs no other resources including tax on the wealthiest. (Please visit http://www.kare11.com/news/news_article.aspx?st… for detailed infos).

    As much as 30 percent of all health-care spending in the U.S. -some $700 billion a year- may be wasted on tests and treatments that do not improve the health of the recipients,” Thus the remaining $239 billions over a decade do not matter.
    Dr. Armadio at Mayo clinic says, “If we got rid of that stuff, we save a third of all that we spend and that is 2.5 trillion dollars on health care. A third of that and that is 700 billion dollars a year. That covers a lot of uninsured people.”

    1. There is no need for infighting and class conflict.

    2. It can satisfy revenue-neutral raised by the Republicans.

    3. It is able to resolve the regional disparity.

    4. It may bring the private insurers to competition, innovation.

    5. The focus on 'outcome' over volume can make the practitioners more accurate and creative based on IT SYSTEM and evidence, while eliminating the additional, unnecessary care that is increasing patients' pains, frustrations, and possible side-effects.

    6. It undoubtedly allows for massive medical job creation.

    7. The desperate people will get back American dream.

    THANK YOU !

  • HSR0601

    A pay for outcome / value payment system, key to the deficit-neutral, might be capable of bringing all groups together.

    Supporters of the agreement say it could save the Medicare System more than $100 billion a year and 'improve' care, that means more than $1trillian over a decade, and virtually needs no other resources including tax on the wealthiest. (Please visit http://www.kare11.com/news/news_article.aspx?st… for detailed infos).

    As much as 30 percent of all health-care spending in the U.S. -some $700 billion a year- may be wasted on tests and treatments that do not improve the health of the recipients,” Thus the remaining $239 billions over a decade do not matter.
    Dr. Armadio at Mayo clinic says, “If we got rid of that stuff, we save a third of all that we spend and that is 2.5 trillion dollars on health care. A third of that and that is 700 billion dollars a year. That covers a lot of uninsured people.”

    1. There is no need for infighting and class conflict.

    2. It can satisfy revenue-neutral raised by the Republicans.

    3. It is able to resolve the regional disparity.

    4. It may bring the private insurers to competition, innovation.

    5. The focus on 'outcome' over volume can make the practitioners more accurate and creative based on IT SYSTEM and evidence, while eliminating the additional, unnecessary care that is increasing patients' pains, frustrations, and possible side-effects.

    6. It undoubtedly allows for massive medical job creation.

    7. The desperate people will get back American dream.

    THANK YOU !

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