Senate Finance Committee

Article from WSJ on gang of six discussions. No big changes, heading for what we have been headed for all summer:

Consensus:
*Individual mandate of some sort whether in name or function;
*Employer mandate whether in name or function; continued strong link of insurance with jobs, with attempts to get those falling through cracks to get coverage.
*end pre-existing condition, bring about guarantee issue, with some control of what premium can be charged
*subsidy for persons without insurance to buy insurance via some sort of mechanism to set up a market in which people can shop for policies; (house likely end up with bigger subsidies and subsidy higher up the income ladder)
*some Medicaid expansion
*part of 10 year financing of insurance expansions via cuts to Medicare and Medicaid

Big Stumbles/Differences
*public option whereby people could choose to buy into a publicly run insurance plan (house yea, senate nay).
*Other financing: house income tax increase; senate limiting tax exclusion of employer paid benefits aka taxing private health insurance benefits

Seems likely that none of the Republicans will vote for the bill....Snowe most likely....but negotiating with the Republicans is not that much different than negotiating with the 4 or 5 most conservative Democrats in the Senate who would be needed to break a filibuster (if Kennedy and Byrd and physically able to vote).

I think Sen. Snowe's comment in the article that this entire debate is 'one last chance' for the private insurance approach to work broadly for the US. There are those that think that is hopeless and those that do not.

Many other questions and lots of screaming to come, but this is the outline of the debate.
Big questions: how many can be covered in this way?
will there be increases in competition among private insurance companies that will lead to decreases in cost in the non-elderly market?
Will there be some sort of Independent Medicare Commission developed to address payment, quality, etc......I think the only hope of reasonably addressing cost inflation in the program.

The News and Observer has a bit in today's paper discussing competition in the insurance market; short version is that many states have a very dominant insurer. Blue Cross/Blue Shield of NC has 96.8% of the individual purchase market in NC, and 77.8% of group insurance sales in NC.

My hunch of what turns into the biggest political football of the fall: malpractice reform. In fact, I would stay up all night (after night, after night) watching the Senate debate a bill with two things: public option and a stringent malpractice reform.....