The point man this time is Democrat Max Baucus, an unassuming, neighborly lawyer from Helena, Mont., who chairs the Senate Finance Committee.
For the past year, Baucus has been holding hearings and meeting with various interests to cobble together consensus on what he says is the most difficult legislative challenge of his career.
Baucus, 67, has set broad parameters on what he wants accomplished: It must be bipartisan, it must include a combination of public and private resources, and it must be delivered to President Barack Obama's desk by the end of the year. Everything else, he said, is pretty much negotiable.
"I don't have an ideology," he said.
Comprehensive health-care reform hasn't been tackled in Congress since Clinton's efforts spawned a national backlash that helped cost the Democrats control of Congress 15 years ago.
But advocates say the issue has to be addressed — as unemployment rises, health costs increase and about one in four Americans are either underinsured or have no coverage. With a popular president who wants health-care reform, Baucus knows this may be the only window for action.
Gannett Washington Bureau sat down with the Montana Democrat to talk about the issue and his expectations:
You've called health care a moral and economic imperative. What do you mean?
We can't keep going on like this. Costs are going to go through the roof. American companies will not be able to compete with other countries' companies. Look at GM. They're in a world of hurt in many respects because of their health-care bills. They signed new contracts with employees and retirees to give Cadillac coverage. Holy mackerel, that's expensive. When you buy a car, close to $1,500 of that car is health-care costs in this country. In Japan, it's about $400. If these costs keep going up in America, this make it very, very hard to compete.
It's the right thing to do. People should have health insurance. The United States should have a system where you get access to good, affordable quality health care.
What's the problem with the current system?
We don't have a health-care system in America today. It's a hodgepodge, a collection of many different groups, each providing health care in one way or another: doctors, hospitals, insurance companies, medical device manufacturers, pharmaceuticals. As a consequence, there's a lot of waste in the current system, and health- care quality is very uneven in some parts of America. Many people don't have health insurance, and costs are very high because of the waste.
And you think the system improperly rewards quantity over quality?
We pay doctors and hospitals based on volume. The more services a doctor provides, the more a hospital provides, the more (they) get paid. We don't reimburse on the basis of quality. If you want to buy a new car, you want to know something about the quality of the car. You go to Consumer Reports, you ask a buddy, you kick the tires, you open and close the doors, and you try to get a sense of what the quality is. You don't do that with doctors because you don't know enough about what they do to ask the right questions.
What kind of plan would you like to see in place?
We spend twice as much per capita on health care than do people in the next-most-expensive country. We're the only industrialized country without health insurance for everybody. That's incredible when you stop and think about it. So what's my perfect plan? Basically, I'd like to see a system in America where everyone knows that he or she (has) quality health insurance and will get quality care and costs are manageable, (increasing yearly) at no more than roughly inflation.
Even though Democrats control Congress, you've talked about a plan that has Republican buy-in as well. Why?
I think it's very important to have a bipartisan bill because then it's more sustainable. It will have more national support.
Will this be any different from 1993, when President Bill Clinton's proposal for universal health care went nowhere?
We've learned lessons from '93. The (Clinton) administration gave this 1,600-page bill to Congress and said: "Here it is. Pass it." Obama, on the other hand, said: "Hey Congress, here are some principles. You do it and make it better because you'll give us more buy-in and expose it to more people around the country, so we're less likely to make mistakes."
And you think the time is right?
The problems are much greater now than they were in '93. The costs are much higher. The demand for change is much greater. The stars just seem to be aligned.
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