Three More Thoughts on the Baucus Bill

I agree with Professor David Orentlicher’s assessment on the Baucus bill: We are likely to get “a series of half measures (or less than half measures.”

Much of the time, a half a loaf is better than none, but I am not sure that the half-a-loaf argument holds true in this instance. Why? For three reasons:

First: the debate is being driven by personalities as much as anything. The questions driving Washington DC these days are soap-operatic: Will Barack Obama get his bill through? Will Max Baucus prove to be a champ, or a chump? Will the House Democrats stick up for the “public option”? And how will the Democrats get their revenge on the insurance industry? And how ‘bout that Olympia Snowe? A backbencher for years, what a player she is now! And who else wants to be the swing vote in the Senate? Susan Collins? Joe Lieberman? There’s nothing wrong with personality in politics, but if personality-politics become paramount, then, by definition, other goals--such as good health care and medicine policy--must come in second. Politics has always been about personality, of course, but in the past, parties felt a duty to their platform and to their principles. So amidst all the to-ing and fro-ing, there was always the sense that the parties were working toward a pre-defined laid-out goal. I don’t think that can be said anymore. I think that personality has become so dominant--aided by television--that policy has become just another tool in the toolbox, a means to an end, as opposed to the end itself.

Second, as I have argued here at SMS in the past, the numbers which are being allowed--“concocted” is an equally good verb--to dominate are dubious in the extreme. The CBO says that the Baucus bill will cost $829 billion over ten years. Are they sure? Are you sure?

Obama is sure, at least for now. As the President said on Tuesday, “And as the nonpartisan Congressional Budget Office has certified, it will slow the growth of health care costs in the long term and it will not add a penny to our deficit.” Any more questions?


Well, yes. Think back a decade, to 1999, when the federal budget was running huge surpluses. Back then, did anyone have any idea what would happen to the budget, or the budget deficit, in the wake of the tech bubble, 9-11, the Iraq war, oil price spikes, and then the Wall Street meltdown? Of course not. Nobody could know. And go back 10 years before that to 1989, who could have predicted that the economy would boom the way that it did--and that those surpluses would emerge in the late 90s?

For what it’s worth, Michael Cannon at the Cato Institute says it will cost $2 trillion. Cannon is an avowed foe of the bill, but he makes a good point: Congress is not likely to truly cut Medicare, or anything else. And everybody on Capitol Hill knows that, too, but they don't want to vote for a $2 trillion bill, they want to vote for an $829 billion bill. Somebody down the road, after the current crop of incumbents is re-elected, can worry about that $1.2 trillion gap.

(No wonder the scramble is on for tax revenue; James Lucier of Capital Alpha Partners, DC-based investment research firm, sent a headline flash to his clients this morning, “All Manner of Tax Hikes Under Consideration as Healthcare Enters Endgame.”)

Third, I have my doubts on the strategic-intellectual framework by which the current generation of healthcare-iors are operating. To put it bluntly, I think that they are fetishizing politics and finance at the expense of science.

What’s the real issue at hand here? What's the true objective? As they say in the military, “What’s the main effort?” Not so long ago, it was understood that the primary purpose of medicine was to cure disease. Scientists, from Louis Pasteur to Paul Ehrlich were heroes--they even got movie biopics made about their lives. As they should have, because they saved millions of lives.

But in the past three or four decades, the political focus has shifted from “medicine” to “health care,” and then it shifted yet again, to “health insurance.” This is a bit of semantic slippage that should have gotten more pushback than it did. But now we live in a world where the main effort has shifted from cures to cards.

Shifted, that is, from the search for new medical cures to a commitment to giving everyone--well, almost everyone--a card that says “health insurance.” Speaking of myself, and I think for most Americans, I’d rather have the cure.