Look, there is no way you could call the Wyden-Bennett bill liberal.  It had real bipartisan support – and for good reason.  It was a market-based, voucher approach to insurance that would have eliminated Medicaid, decoupled insurance from employment, and made the country into a massive exchange.

It’s not even close to single-payer.  And, while it is reform, it has enjoyed plenty of support in the past from people on both sides of the aisle.

And for this, Bennet is likely to lose the Republican primary.  As Ezra Klein says:

Bennett isn’t a liberal. He’s not even a moderate. But he’s a legislator: He’s willing to work with the other side to get things done. And he’s paying for it now.

The result of this isn’t just that Bob Bennett might lose his seat. It’s that other legislators will stop legislating. It’s that all Bennett’s friends will see what happened to their old colleague and go pale. It’s that compromise will become too dangerous to seriously contemplate, and so the possibility for compromise will become even more remote.

At some point, maybe this is a good thing. If compromise is impossible, better that we just get some loons into the Senate and admit the institution’s modern composition and lift the strictures on majority action. But let’s at least call this what it is: Bennett is not in trouble because he is a liberal. He’s in trouble because he’s a legislator.

I’ve said it again and again.  There is still much work to be done.  This bodes poorly for any of it happening.

1. Voluntary purchasing pools: Give individuals and small businesses the opportunities that large businesses and the government have to seek lower insurance costs.

Hmmmm.  Sounds like an insurance exchange.  Sounds like the Wyden-Bennett bill.  In fact, sounds like he wants businesses allowed in the exchange, which many Republicans seem to oppose.

2. Portability: As people change jobs or move across state lines, they change insurance plans. By allowing consumers to “own” their policies, insurers would have incentive to make more investments in prevention and in managing chronic conditions.

Is there anyone who disagrees with this anymore?  Again, sounds suspiciously like what we’d get with a robust exchange or the Wyden-Bennett bill.  Or the Wyden Amendment.

3. Lawsuit reform: It makes no sense to ignore one of the biggest cost drivers in the system — the cost of defensive medicine, largely driven by lawsuits. Worse, many doctors have stopped performing high-risk procedures for fear of liability.

Tort reform! Oh yeah, we talked about that already.

4. Require coverage of preexisting conditions: Insurance should not be least accessible when it is needed most. Companies should be incentivized to focus on delivering high-quality effective care, not to avoid covering the sick.

…. Is this not the whole thrust of President Obama’s plan?  Cover pre-existing conditions?

5. Transparency and payment reform: Consumers have more information when choosing a car or restaurant than when selecting a health-care provider. Provider quality and cost should be plainly available to consumers, and payment systems should be based on outcomes, not volume. Today’s system results in wide variations in treatment instead of the consistent application of best practices. We must reward efficiency and quality.

Everyone wants this.  Find me anyone who opposes this.  Seriously.  I want to meet them.

6. Electronic medical records: The current system of paper records threatens patient privacy and leads to bad outcomes and higher costs.

Well, I dispute this.  I think there is insufficient evidence to prove this will lower costs.  I do think that it may improve outcomes.  But his argument isn’t with me, it’s with the Democrats.  And they totally agree with him.

7. Tax-free health savings accounts: HSAs have helped reduce costs for employers and consumers. Some businesses have seen their costs decrease by double-digit percentages. But current regulations discourage individuals and small businesses from utilizing HSAs.

Huh?  These have been around for years.  They won’t work as promised.  But that hasn’t prevented them from being around.  What is he talking about?

8. Reward healthy lifestyle choices: Providing premium rebates and other incentives to people who make healthy choices or participate in management of their chronic diseases has been shown to reduce costs and improve health.

This is another low hanging fruit.  Personally, I don’t think this will do much.  We already reward those who don’t smoke with lower rates.  People still smoke.  And good luck trying to make people less obese.  Because, you know, we’ve been trying to do that unsuccessfully for a long time now.  This is nibbling at the edges.

9. Cover young adults: A large portion of the uninsured are people who cannot afford coverage after they have “aged out” of their parents’ policies. Permitting young people to stay on their parents’ plans longer would reduce the number of uninsured and keep healthy people in insurance risk pools — helping to lower premiums for everyone.

Yep.  Get everyone in the system.  Want to join the mandate train, Governor?

10.  Refundable tax credits (for the uninsured and those who would benefit from greater flexibility of coverage): Redirecting some of the billions already spent on the uninsured will help make non-emergency care outside the emergency room affordable for millions and will provide choices of coverage through the private market rather than forcing people into a government-run system. We should trust American families to make choices for themselves while we ensure they have access to quality, affordable health care.

Sounds suspiciously like giving people subsidies so they can buy their own insurance.  Much like… wait for it… HR3200.  Yes, he’s against a public plan.  So he would support the bill without a public plan?

Can someone tell me where the radical new ideas are?  Or, perhaps, how this truly differs from HR3200 with a robust exchange and no public plan?  Or the Wyden-Bennett bill?

Welcome to the table, Governor Jindal!

UPDATE: Forgot a link!

I’ve been watching the Senate Finance Committee all week to see how they ruled on a number of issues.  They didn’t like the two clear public options.  They did pass Senator Cantwell’s sorta maybe public option (albeit barely).  All week, though, I’ve been waiting to see what would happen to the Wyden Amendment.

You remember that one?  I devoted a pretty long post to it, in fact.  It had bipartisan support and might satisfy a number of competition/consumer choice cries.  The CBO even said it was cost-saving.  So how did it fare?

There wasn’t even a vote! Per Ezra Klein:

Instead, Max Baucus ruled it out of order. The reason? It didn’t have a full CBO score. This came as a surprise to Wyden and his team, who’d gotten the amendment scored by the CBO, and had been in endless negotiations with Baucus, the White House, employers, and labor over the past week. If the score was in fact partial, as Baucus claimed, you’d think someone might have mentioned it.

That’s… hard to swallow.  Read Ezra on his thoughts on why this happened; I don’t like to speculate on such matters.  But once again, we seem to have rejected a piece of legislation that might have lowered the cost.  Remember that the next time someone complains about the size of the deficit.

I still think they are going to pass a bill eventually.  But it’s going to be expensive.

Basically, “The Free Choice Proposal” (as it is known) offers the following provisions:

1) Employers that offer group health coverage must offer the equivalent of a minimum benefit plan, contribute at least 70% of the premium, and offer at least one other health plan of greater actuarial value; or

2) Employers that do not offer the choice of a low cost option must offer workers a voucher worth at least 70% of the average of the three lowest cost plans in the change; or

3) With an adequate transition, employers can take their entire group to the exchange where they would receive a group discount so long as they provide at least 70% of the cost of average of the three lowest cost plans in the exchange; or

4) Employers that do not offer health insurance choices, a voucher, or go to the exchange, would have to pay a “fair share” fee which would be a percent of the national average of the three lowest cost plans in each state.

In essence, there will be an individual mandate.  Employers will either have to offer at least two options to their employees and pay a large chunk of premiums, or give them a voucher to help them buy insurance on the exchange.  The major difference between this and all the other bills, it that it will likely result in a lot of people (if not everyone) getting their insurance through the exchange.  HR3200, and the HELP bill, actually prohibit many employers from going to the exchange.  President Obama, and many others, have been so intent on keeping the employer based system in place, that this likely scares them.

Some have argued that this could lead to a fractured risk pool.  Senator Wyden counters this with a national reinsurance pool to protect those whose costs are higher than expected.  This is accompanied by provisions already in Senator Baucus’ bill that perform risk adjustments.

On the other hand, this bill has been scored amazingly well by the CBO.  And – shockingly -the bill itself has a number of Republican co-sponsors.  It also has the support of a number of knowledgeable people all over the ideological spectrum.

If you want my opinion, here it is.  I’d feel better about it with the addition of a public option, but if you think that the competition provided by the insurance exchange is a good thing, then letting everyone in is even better.  This would do more to contain costs than anything else I’ve yet seen. The difference is that a single-payer system might contain costs by providing less money to the system overall, ideally leading to a wider discussion of how and what we want to pay for.  This plan, on the other hand, controls costs by putting the incentives on individuals to buy less.  I think the better way to reduce costs is at the provider end, not the patient end.

But I live in the real world.  I recognize that those opposed to a single payer plan fear that my preferred method would result in rationing, instead of rational decisions about the use of more cost-effective treatments that I think could occur.  I also recognize that they think incentivizing consumers will result in better shopping and price reductions without negative health consequences, instead of the forgoing of needed care that I fear might occur.

I believe the evidence shows I’m right, but smart people I respect disagree.  I also acknowledge that we can fix things down the road if they don’t work out as we hope, as nothing is forever.  Therefore, although I would prefer a single payer plan, I recognize that Senator Wyden’s amendment would at least start to contain costs while still achieving the major goals of reform.  Senator Baucus’ bill is better with it than without it.