Boston Globe editorial: A compromised health bill

[ProSense]

Globe Editorial

A compromised health bill

September 18, 2009

SENATE Finance Committee Chairman Max Baucus made lots of concessions as he put together his health reform bill, in the hopes of attracting at least one Republican supporter. Sadly, none emerged. So while the bill that Baucus offered Wednesday is encouraging in a way - it endorses the goal of universal coverage and includes some crucial building blocks of a reform package - it gives away too many reforms that would help hold down costs for the public and increase access to care.

Like Obama and some of Baucus’s fellow congressional leaders, he leans heavily on Massachusetts’ framework for full coverage: Anyone who is not insured at work or by Medicare or Medicaid would have to buy insurance from private carriers. The government would subsidize premiums for some customers, and insurers would be forbidden to reject customers for preexisting conditions.

But unlike Obama and plans offered by other congressional committees, Baucus would not set up a public insurance option for customers who are forced to buy coverage on the private market. Instead, Washington would foster member-owned, nonprofit insurance cooperatives, which are unlikely to have the market clout to demand lower rates from hospitals or drug companies. He would offer smaller subsidies to the uninsured. And, by penalizing employers whose workers receive subsidized coverage, Baucus would discourage firms from hiring low-income workers, especially ones with children.

Other congressional proposals follow the Massachusetts model in another crucial way: An insurance “exchange’’ would present a limited number of easy-to-compare benefit plans from qualified providers. But Baucus’s “yellow pages’’ online listing of all licensed carriers in any area would yield sneaky fine print and customer confusion. Another questionable provision of Baucus’s proposal would allow insurers to charge older customers as much as five times the rates for young customers. It’s fair to take some account of older customers’ higher medical bills, but in Massachusetts the allowable cost differential is 2 to 1.

In pursuit of compromise, Baucus stripped away some key elements of reform. Senators should get to work on adding them back.