Scott J. Ferrell/Congressional Quarterly/NewsCom

More of the same

Healthcare | Loaded with mandates, taxes, and rules, the Baucus plan hits a weary Capitol Hill

Issue: "Africa, Inc.," Oct. 10, 2009

Leaving a packed Senate committee room after a briefing by no fewer than 15 congressional staffers on the latest bill to redo America's healthcare system, one reporter uttered: "I think I understood about 40 percent of that."

Indeed, with the introduction in Congress of the third healthcare bill in less than four months-this time from Senate Finance Committee Chairman Max Baucus-confusion reigns. Even people who work on Capitol Hill spent much of the past week trying to discern the details in what many predict will be the template for the Democrats' final fall push at over­hauling healthcare.

The quick answer: The bill, despite talks of bipartisanship, is not fundamentally different than the controversial House bill that heated up town hall meetings. It expands Medicaid, provides subsidies to even portions of the middle class, and makes almost everyone buy insurance or face a penalty. It alarmingly leaves unresolved many of the summer's biggest hot button controversies by failing to include sufficient controls to prevent federal funding for both abortion and the insuring of illegal immigrants.

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The bill also creatively engages in some fancy name changing to skirt other red flags: replacing the controversial "comparative effectiveness training" slogan with the new term "patient-centered outcomes research" and dispatching a government-run insurance option with a "co-op" concept that-with $6 billion in federal seed funding and the regulatory power it grants to the HHS Secretary-is really a public option in disguise.

But since this is the Finance Committee, the nearly $900 billion Baucus bill did provide new insights on how lawmakers will attempt to pay for it all: $350 billion in new taxes. "This plan raises taxes on virtually every American who uses our healthcare system," said Senate Minority Leader Mitch McConnell.

The bill unleashes a tax on insurance companies that likely will be passed on to consumers; a tax on those who don't have insurance, which would top out at $3,800; and new taxes on medical devices (including contact lenses), lab tests, and prescription drugs.

The ink had barely dried on the plan before it started getting decidedly mixed reviews from both parties. Even Democrats fear that the proposed tax on high-cost insurance plans would hit a large swath of the middle class. "Baucus wanted a grand bipartisan compromise, but the only thing bipartisan about it is the opposition to it," said Greg D'Angelo with the Heritage Foundation. Lawmakers quickly introduced 564 amendments to the bill.

A central battleground will be its proposed $600 billion in cuts to Medicare, which President Barack Obama says will be accomplished through better efficiency. "What is amazing is that the president thinks the very government entity that created the waste, fraud, and abuse will be able to get in there, find it, and eliminate it," said Bob Adams, the executive director of the League of American Voters.

Twila Brase, president of Citizens' Council on Health Care, said the bill contains "rule after rule, mandate after mandate, and government report after government report" that creates a "one-size-fits-all treatment mentality" and threatens to turn doctors into nothing more than "lab technicians for the government."

"The federal government does not have a medical license," Brase argues.

But just as worrisome as such provisions as the creation of a $1.5 billion system for government-approved in-home parenting lessons is the wide latitude the bill gives to the Department of Health and Human Services and to the IRS. HHS is mentioned nearly 100 times in the bill's 223 pages, empowering its secretary to designate, establish, implement, define, approve, set, and determine a vast array of the reform's nuts and bolts. And in a kiss-off to patient privacy, the IRS will have to gather detailed health information on Americans in order to collect penalties.

Reading the bill makes it clear that government will be in charge of determining what a required insurance plan should cover and cost as well as how to collect taxes for noncompliance. This, Brase fears, could lead to a "new healthcare system in America that will be very expensive and very bureaucratic."

Edward Lee Pitts
Edward Lee Pitts

Lee teaches journalism at Dordt College in Sioux Center, Iowa, and is the associate dean of the World Journalism Institute.


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