No surprise here, but all the major unions are encouraging Sen. Ted Kennedy (D-Mass.) and his staff to structure his health care reform legislation around a single payer model, similar to H.R. 676. In a recent letter to Sen. Kennedy, the All Unions Committee for Single Payer Healthcare argued against multiple payers, saying

Any plan that keeps the profit-making insurance companies in the mix will add layers of bureaucracy, will not be able to control costs, and will fail in the noble effort to bring good care to all.

Kennedy will have his plan ready after the first of the year sometime. But it was rumored that Senate Finance Chair Baucus was working with him. Apparently not so. Baucus says Kennedy didn’t work on his plan, but has read it and ‘likes it.’ Time will tell there -- and whether the unions are having any influence on Mr. Kennedy.

But, Sen. Baucus released what he calls his Call to Action—Health Reform 2009 report independently. His is based on a mainly employer-based concept, where employees or employers can opt, with consequences. He demands universal coverage be the goal (Obama has not gone there as of yet).

ACC has a detailed summary of Baucus’ strategy with annotations according to our policy views. Baucus did not propose this as a bill. The bill or bills will come later after the first of the year. But here are the essentials of his 89-page proposal from my read: [more]

• Our current healthcare system is broken because it focuses on more care, not better care, yet spends twice as much as any other country; and we are 19 of 19 of the top nations in preventable deaths, while costs are escalating in a non-sustainable fashion.  Fixing the system has got to happen now -- even if expensive -- and it will stimulate the economy and save business.
• The Proposal details include:
  • Universal coverage is promoted by insurance reforms to keep costs down (can’t deny coverage or penalize for pre-existing conditions), and with a transparently priced national purchasing exchange to help individuals get more choices and fair prices for different plans (above a minimum coverage requirement). No limits on insurance profits.
  • Every citizen has to have coverage, and there would be tax consequences (unspecified) for individuals who don’t get coverage through their employer or directly themselves through the purchasing exchange.
  • He wants to build on existing employer coverage. Businesses either continue to cover, or pay a penalty (pay or play) to enable their workers to get coverage thru the national purchasing exchange, and with tax subsidies to workers without employer coverage. Employees who buy their own coverage could do so with pre-tax dollars deducted from their pay by their employer.
  • Medicaid would become available to all low-income Americans (men and women), and S-CHIP is expanded to kids up to 250% of the FPL. Community Clinics and Indian Health Service also get more money.
  • Small businesses get a special tax credit to offer coverage if they choose to do so voluntarily; otherwise their employees get coverage through the exchange.
  • Increased emphasis on preventive care. High cost procedures will be cut, and prevention reimbursement increased. He thinks this produces savings.
  • More money for primary care, including the medical home idea; money comes from reducing specialist and procedure reimbursements some. He knows this will be tough, and wants doctors to help him accomplish this!
  • Increased emphasis on quality of care over quantity, with mechanisms that ACC and NCDR may benefit from, I would think. We are mentioned in the plan as model programs for advanced reporting.
  • Physician payment incentives will change to promote quality and efficiency. We know this has to happen. He would also be open to gain-sharing options for doctors and hospitals to promote quality. He will somehow fix the SGR. All payment reforms apply only to Medicare.
  • HIT gets incentives also. But not the kind I think will work. He proposes loans and subsidies, rather than the kind of increased payment that will make a business case sufficient to truly promote adoption.
  • He would allow certain people over 55 to buy in to Medicare.
  • He provides semi-token tort reform funding to states to streamline tort systems, but no major change.
  • Not much mention of pharmacy benefits reforms.
  • Also, people who want to keep their current insurance plan can do so

Baucus doesn’t say how much this will cost, but implies it will save money after 5 years, and will slow cost growth all along. CBO has not yet spoken.

There are a lot of controversial things here. But it’s fairly comprehensive.

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