The health care push is deadlocked right now as everybody waits
to see what emerges from the Senate Finance Committee, where
Republicans Chuck Grassley, Mike Enzi and Olympia Snowe are
trying to hash out a deal with Democratic Chairman Max Baucus and
two other more moderate Democrats. But the dribs and drabs of
information we do have about what they are considering make it
sound like a plan that would be acceptable neither to
conservatives nor liberals. From what we know so far, that the
deal is likely to create some sort of non-profit co-op insurer to
compete with private insurers as a substitute for creating a new
government-run plan and it will drop a mandate that would tax
employers who did not provide health care.
For liberals, this would simply be unacceptable. To them, the
creation of a government-run plan is not just one feature among
many, but the central part of reforming the health care system --
this is especially true among those who are single-payer
advocates at heart. And liberals don't think that a non-profit
co-op would have the scope to really drive down prices and
threaten private insurers (or as they would say, "keep private
insurers honest"). Asking them to drop a government plan is
difficult enough as it is, but to also drop the idea of an
employer mandate will be even harder to swallow. Furthermore, as
we've seen so far, having an employer mandate helps the
evaluation of the Congressional Budget Office. Not only does the
tax raise some money and help marginally with financing, but the
CBO thinks that if employers would face a penalty for not
providing coverage, few would drop coverage -- meaning the
mandate makes it easier for Democrats to claim that people who
like the insurance they have, can keep it, and helps them get
closer to universal coverage. Absent the mandate, the CBO has
found, a lot more employers would drop coverage -- providing
Republicans with the talking point that millions would lose their
employer-based health care.
At the same time, assuming the agreement maintains features of
other bills, I don't see how it would be acceptable to any actual
conservative. While a co-op would not be as bad as a
government-run plan, we'd most likely still end up with a system
in which government provides subsidies to individuals to purchase
government-designed insurance from a government-run exchange. And
if they want the CBO to score the bill as coming close to
universal coverage, those subsidies would have to be generous,
and the bill would also have to include an expansion of Medicaid.
Both in terms of regulation and the creation of the exchange,
you'd still be creating the infastructure for the eventual
government takeover of health care. You'd basically have a system
like the failed and financially unsustainable model they have in
Massachusstets. As time goes by, Congress could easily make more
people and employers eligible to join the exchange, and perhaps
add a government plan down the road (or even take over the co-op
plan if it runs into trouble).
Politically, a Finance Committee agreement before recess would
provide some face-saving momentum for the Obama administration,
and allow them to point to some bipartisan cooperation. But I
don't see how it solves the larger issue -- how do you create a
bill that is acceptable to both liberals and moderate Democrats?