Jon Chait notes that the arbitrary deadline on completely a health reform bill that Max Baucus is now deriding is a deadline that Baucus himself set. That said, in the annals of Baucus health reform flip-flops this is pretty small beer. Comprehensive health reform is hard, and the United States Senate is not all that friendly to progressive policy. But one of the big reasons — in many ways the single most important reason — to have been optimistic about progressive health care policy is the stuff Max Baucus was saying during the transition.
To grasp the significance of this you have to understand that Baucus is not very liberal. In the 110th Senate nine Democrats were to his right. In the 109th Senate and the 108th Senate, just two Democrats were to his right. So in general, Baucus saying something isn’t like Ted Kennedy or Pat Leahy saying it. Bills Baucus is prepared to vote for are bills that have a very good chance of becoming law. And in November of 2008 he unveiled a sketch of principles for health reform. And what did it say? Well, as Ezra Klein summarized at the time:
The plan sets up a Health Insurance Exchange — similar to the exchange envisioned by Obama — where the government would set up a market pitting regulated private and public insurance options against each other. The plan specifically says that individuals and small businesses could buy into the market. As for midsize and large businesses, more on that in a moment. Importantly, the Exchange is not the only space where insurers will find themselves subject to new regulation. “Under the Baucus plan, insurance companies could not deny coverage to any individual nor discriminate against individuals with pre-existing conditions…[this] would apply in the Exchange as well as the private non-group and small group markets.” In other words, everywhere. An important addendum to the exchange is that while the Exchange is being set-up, Medicare is opened to anyone between 55 and 64 who doesn’t have employer based health coverage. After that point, no new applicants in that age range are accepted, but those who bought into Medicare can stay in the program, or move to the Health Insurance Exchange.
The plan aims for something close to universality through an employer mandate. “Once affordable, high-quality, and meaningful health insurance options are available to all Americans, it will be each individual’s responsibility to have coverage.” To aid in this, the plan subsidies the cost of health insurance for folks making up to 400 percent of the poverty line (85 percent of the uninsured are below 400 percent of the poverty line).
In other words, on the points that are now in contention between Baucus’ Finance Committee and the HELP and House bills, Baucus used to be on the other side. Baucus’ sketch includes a public option. It involves subsidies of up to 400 percent of the federal poverty line. It features an employer mandate. What’s more, in crucial respects Baucus’ sketch was to the left of what’s currently in the House and HELP bills. It includes Medicare expansion, and envisions a bolder role for “exchanges” and therefore for government regulation and the public plan.
If Henry Waxman’s staff had floated this plan and Baucus had said he didn’t think it was going to fly, then people would have said to themselves “well, it’s hard to pass ambitious health reform in the Senate.” But when you have an extremely powerful centrist Democrat saying he wants to do this stuff then people start expecting it to happen. And Baucus hasn’t, as far as I’m aware, given any sort of explanation as to why he’s started to have such serious doubts about the approach he spent last year developing.