HELENA - Sen. Max Baucus' ambitious health care reform plan, released two weeks ago, contains some good ideas and laudable goals. But we should be clear about what it's not, and what it does not do.
First and foremost, it is not "universal coverage" or "universal health care," which means providing basic health coverage to all Americans, regardless of their ability to pay.
Baucus staffers say it would come close to universal coverage over several years, by expanding public programs and requiring everyone to buy health insurance. Still, that prospect relies on the private, for-profit insurance market to fill some big gaps - something it hasn't done after decades of being in business.
It is also not a national health care plan, which would be one, overarching program that replaces the messy, expensive and inadequate hodgepodge of coverage and care we have now.
There's more on the "not" side, which we'll discuss in a minute. But first, let's explain what the Baucus plan does do, or hopes to do, when it comes to revising our health care system.
Baucus, a Democrat and the chairman of the powerful Senate Finance Committee, unveiled his plan at a Nov. 12 press conference in Washington. It's similar to proposals advanced by President-elect Barack Obama, and undoubtedly his bill will be a key piece when the 2009 Congress tackles health care reform.
It would expand or simplify government-funded insurance plans for several populations: the elderly (Medicare), the poor (Medicaid), kids from low- and moderate-income families (Children's Health Insurance Plan) and Native Americans (Indian Health Service).
It would leave in place employer-provided health insurance, which covers some 160 million people, or half the population. However, it suggests that a portion of these now tax-free benefits might be taxed.
And, finally, for the 40-odd million Americans still without health insurance, it would require them to buy it, either through their employer or from the private market.
To attempt to make this insurance affordable, the Baucus plan would create an elaborate network of incentives, structures and rules.
Larger businesses that don't buy insurance for employees would pay into a fund, which would help subsidize the purchase of insurance by others. Tax incentives, subsidies or both would be offered to small businesses and individuals to help them buy insurance.
A cornerstone of this part of the plan is a "Health Insurance Exchange," which would be a national clearinghouse of private insurance plans. They would be subject to strict rules: You couldn't be denied coverage for pre-existing conditions, the policies would offer basic coverage and a presidential board would enforce some sort of ceiling on the price.
The insurance industry likes the Health Insurance Exchange - if it comes with a mandate to buy coverage. So, the industry gets 40 million new customers required to buy insurance, in exchange for some limits on what it can offer and charge.
The Baucus plan also includes other proposals that most people agree are good things: increased payments to primary-care doctors, like family practitioners, and reduced payments to specialists, to address a growing shortage of primary-care physicians; an emphasis on preventive care, including government-provided care to those without insurance; and creating standards for computerized health records, so medical providers nationwide can transmit patient data more easily.
Yet is this package the best prescription for curing America's ailing health care system?
As I said earlier, it is not a national plan that simplifies things. It takes our fragmented, expensive system - the most expensive in the world, mind you - and plops another mishmash of new rules, regulations and bureaucracy on top of it, all in the name of maintaining the private, for-profit insurance market.
Baucus will argue that it creates some national standards for this market, aiming to make it more affordable. But what about the administrative costs of private health insurance, at 15 percent to 25 percent of overall premiums? We'd still be paying it.
We also don't know, yet, what all of its subsidies and other expenses would cost.
It does little to control rising health care costs. It would create a new institute to study "comparative effectiveness" of health care procedures, to see if we're paying for stuff that isn't necessary.
For those with employer-based health insurance, the Baucus plan does nothing. Don't like the plan your employer offers? Paying too much for too little? Your only option is to enter the individual private market. Good luck. And if you lose your job, you'd still lose your health insurance.
And yes, it does offer expanded Medicare for those want to "buy in" to the plan at age 55. But that buy-in would be high-priced for the consumer, and we'd be expanding the Medicare pool with more unhealthy people - maybe not the best way to ensure the long-term financial health of Medicare.
It criticizes "Medicare Advantage," a product that allows private insurers to offer Medicare coverage at higher prices, but doesn't eliminate it.
It says we need more information on drug companies offering gifts and incentives to physicians, so doctors will prescribe the companies' products - but doesn't ban the activities.
I could go on, but you get the idea. Yes, the Baucus plan has some good aspects. But it seems to bend over backwards to preserve much of the status quo - a status quo that just about everyone agrees is badly broken.
And when it comes to real reforms, like a national health care plan with one payer or one system, Baucus says that is "off the table," because it's "not politically feasible."
Why? We'll look at that question Monday.
Gazette State Bureau reporter Mike Dennison can be reached at firstname.lastname@example.org or at 800-525-4920 or 406-447-4068.