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The heart of the matter

Sen. Baucus' bill has its critics, but it also brings into focus basic questions about reform.

September 18, 2009

After weeks of talks with a small group of Republicans, Senate Finance Committee Chairman Max Baucus (D-Mont.) released his long-awaited healthcare reform proposal Wednesday with no GOP co-sponsors -- all but eliminating the chance for significant bipartisan support. Baucus' quest was quixotic, especially with leading Republicans denouncing anything that remotely resembles "Obama-care." It also weakened his support among Democrats on his committee, some of whom have already criticized the proposal. Nevertheless, the bill represents an important step forward. Even without Republicans on board, it shifts the debate to the right on several issues at the heart of the reform effort, including how much taxpayers and businesses will pay to help the uninsured buy coverage. That shift presents a chance to bring the public's focus back to the flaws in the current system and the challenges posed by any attempt to fix them.

The finance panel is the last to act on the issue; three committees in the House and one in the Senate have already approved their own measures (over the unified opposition of committee Republicans). Baucus' bill has the same basic outline as those and even as some of the GOP proposals, calling for new regulations on insurers and subsidized marketplaces for individual policies. Where things get interesting is in the differences over who would receive subsidies and how they would be financed.

The Baucus bill would spend significantly less to help low- and moderate-income people afford insurance, offering subsidies to fewer people and at lower amounts. That's the main reason the bill would require far less government spending than the House proposals but also leave millions more people unable to obtain insurance. Baucus is right to be concerned about the cost of extending coverage, but we're skeptical about his methods for saving money. One of the keys to controlling the ruinous rise in healthcare costs is to stop the inefficiencies caused by the uninsured, so Baucus' proposal on subsidies undermines his other efforts to improve the way treatment is delivered and reimbursed.

By taking only partial steps toward universal coverage, Baucus' bill forces lawmakers to consider the very purpose of healthcare reform. It's not just an issue of how to do it, it's a question of why -- and whether universal coverage is a goal or just a byproduct. The contrast between his bill and the earlier proposals helps raise other fundamental questions too, about who should cover the cost of the overhaul and how to promote competition in the insurance market. After weeks of public hysteria about the bills' small details, we welcome the chance for Washington to take up issues that will determine how far-reaching and effective the reform may be.

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