?History is knocking on the door. Let?s open it. Let?s begin the debate.? So declared Max Baucus as the Senate weighed whether to take up a controversial proposal to overhaul America?s bloated health system.</CW>
He can be excused for gushing a bit, as the head of the Senate?s Finance Committee deserves most of the credit for getting health reform as far as it has come this year. Soon after he uttered those words on Nov. 21, the chamber?s Democratic leadership managed to cajole enough of his wavering colleagues to secure 60 votes, the minimum needed to proceed with debate.
The full Senate will take up the matter after the Thanksgiving recess, with the leadership keen to pass it before Christmas. This will not be easy, however. Many members of both parties have made it clear that they do not like parts of the bill as crafted by Baucus and embellished by Harry Reid (the Democrats? leader in the Senate), and intend to offer difficult amendments.
If the bill actually passes, it must still be reconciled with a version recently passed by the House before a unified bill can be sent to the president to be signed into law.
How do the two versions of reform compare? In many ways they are similar. They both promise to extend health insurance coverage to many but not all of the 47 million or so currently uninsured. They propose a comparable mix of individual requirements to buy insurance, targeted subsidies for the poor, penalties and aggressive regulations to achieve that goal.
<CW-16>The nonpartisan Congressional Budget Office estimates that the apparent cost over the next decade of both bills comes in below the $900 billion limit set down by Barack Obama.</CW>
The Senate bill is better in several ways. Its proposal for a government-run insurance plan (or ?public option?), a notion disliked by many market-minded folk, is weaker: the Senate version would allow states to opt out of such a plan.
Another improvement is that the Senate?s plan raises money not by soaking the rich through income taxes, as the House bill envisions, but through excise taxes on the most expensive health policies.
This approach has two advantages. First, it helps tackle one of the greatest distortions in America?s health system: the subsidies given for employer-provided health insurance, which encourage over-insurance.
The second benefit, according to analysis done by the Joint Committee on Taxation, another nonpartisan outfit, is that it will lift salaries for many Americans and raise tax revenues. If a tax motivates firms to trim health benefits, they should increase salaries to compensate.
Another attraction of the Senate plan is that it embraces a proposal put forward by the White House for a (theoretically) nonpartisan commission to deal with cost control. Under the plan, the Independent Medicare Advisory Board would be given a mandate to propose spending cuts and other reforms if health spending exceeds an agreed growth target. These proposals would be presented to the president, who must then immediately submit them to Congress for approval.
Some applaud this as a clever way to get around congressional venality (much as a similar commission managed to close military bases in the past), but skeptics are unconvinced.
Tom Miller of the American Enterprise Institute, a conservative think tank, scoffs that the promised cuts will remain a ?mirage? because politicians and lobbyists will find a way to influence the committee?s decisions. He also thinks it?s wrong to shunt off difficult decisions to undemocratic cabals.