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There's a basic problem at the core of the health care reform debate. Well, a few problems, but let's start with the fact that fixing the health care mess in this country and providing health security to all Americans is not only a massive undertakng, it's on that would be a huge and historical accomplishment for the president and the party who achieved it. Which means the party in the minority has very little incentive to help make it happen--why make it easy for the opposition to do the one thing likely to secure their majority for the next generation? The idea bipartisanship works, as policy analyst Ezra Klein says, when the parties have compatible incentives. On this debate, they don't.

A Doomed Partnership on Healthcare Reform

Which brings us back to Sen. Max Baucus and his ongoing fool’s errand of trying to force this massive, historic, critical piece of reform through a sausage maker with a “bipartisan” widget that just won’t let it come out the other end.

“Fundamentally, legislation that is historic, that is comprehensive, that has a large number of senators supporting it is more durable,” Baucus said in an interview. “It will be more sustainable and will inspire more public confidence.”

Baucus, who came to the Senate in 1979, and Grassley, who joined two years later, have let that philosophy guide them since they assumed senior posts on the finance committee eight years ago.

The two do not socialize outside of the Senate. But since 2001, they have met nearly every Tuesday at 5 p.m. in Baucus’ conference room on the fifth floor of the Hart Senate Office Building. (The coffee is free there, the parsimonious Grassley likes to joke.)

Both men said that they slowly grew to trust one another and to look for places where they could agree.

“We are pragmatists,” Grassley said while in Iowa recently to meet with constituents. “We come from similar states, and I think we have a similar idea of what bipartisanship is all about.”

Said Baucus: “Most people in this country want us to basically work together, to get something done between the 20-yard lines. They are in the center.”

This is a basic misunderstanding of both how historic domestic policy initiatives happen, and believing that what America wants is what the handful of people he spends a lot of time with in Washington tell him it is that American wants. Consider the historical, critical pieces of domestic policy legislation that really improved the lives of Americans–social security, Medicare, Medicaid–how many people now know, or really care, whether the legislation was passed with large bipartisan majorities? These programs didn’t work because of who voted for them, they worked because they are good policy, good governance.

Which is why most people in this country don’t give a hoot whether a bill is bipartisan or not. They want good government. They want a Congress that understands that when they sit down every month to pay the bills, they’re worried. If they’re lucky enough to have insurance, they worry that they’re one round of layoffs away from losing it. Or one serious illness that will give their insurer cause to raise their premiums. What makes comprehensive, historical legislation successful and durable to Americans isn’t who voted for it–it’s whether it worked.

What the majority of Americans want, showing up in poll after poll, is the opportunity to choose between private insurance or a Medicare-like public plan option. They don’t necessarily want to change their own plan right now, but they want to know that the option is out there, as a saftety net for themselves and because, basically, they believe in competition. They want Congress to make a policy change that will make a difference. And what will make a difference? A strong public option that provides real competition to the private insurers and keeps them honest.

They want a plan that works to make their lives better. That’s something that Max Baucus’s supposed bipartisan partner just doesn’t get. Here he is talking to constituents at a town meeting back home in Iowa. When asked about the high cost of health care, Grassley tells the audience that if they want health care coverage as good as he gets as a member of Congress, they should go work for John Deere or the federal government.

Set aside the callousness of Grassley’s response to a concerned constituent. Going to work for the federal government would indeed solve everyone’s health care problems. To demonstrate that health insurance expert broke down the costs for a hypothetical emergency room visit by Sen. Grassley vs. a regular Iowan.

Ok, so it’s probably best to compare family plans, as that’s the number quoted in the video, and Grassley has/had a family.

Here is the info on the FEHBP plan Grassley got until he was 65:

(we’re using Blue Cross because it’s standard and what most people end up buying)

On the last page, you can see the rates. $356.59 per month for the entire family. The benefits are great (see page before the prices, standard benefits, summery of benefits):

$20 co-pay, $200 for any hospital stay of any length, $0 for outpatient services, all subject to a $300 deductible, so you only pay max $300 per visit. Dental included. Annual limit is $5,000.

Compare that to a typical plan for a typical Iowan age 64 with a wife and a kid from http://www.ehealthinsurance.com/

I’m using the bestseller, benefits pasted below.

Monthly costs are $541.23. Deductible is $15,000 ($5,000 per person). You still pay 20% of costs even after the deductible is reached. Annual limit is $21,000.

So, let’s take a scenario. Chuck Grassley, the Senator, gets indigestion but thinks it’s a heart attack and goes to the emergency room. The most he pays for that is $300.

John Doe the Iowan has the same problem. He could be stuck paying $5,000, more if the full bill is higher (he pays 20% of all charges over that).

Great deal Chuck Grassley gets there, subsidized by the federal government and your tax dollars. Does he consider it socialized medicine? Probably not. But he also just basically doesn’t get that people are hurting, that $5,000 for a trip to the emergency room is out of bounds, that his constituents want him to fix that. Chuck Grassley views the health care debate as “more of a political problem than it is a health care problem.” Yes, it’s a political problem. It’s a political problem because Chuck Grassley and the Republicans are making it one, they are putting the politics ahead of the policy.

So the question comes back again, why is Max Baucus letting Chuck Grassley set any of the terms of the debate?

About Joan McCarter

Joan McCarter is a contributing editor at Daily Kos, writing as "mcjoan." She has focused on Iraq, the traditional media, and electoral politics at the blog. During the 2006 election, McCarter focused her writing on Democratic prospects in the west. She traveled throughout the Rocky Mountain states through the last weeks of the campaign, researching and writing about Democratic candidates and campaign strategies. She is currently researching a book on western politics scheduled to be published in spring, 2008. McCarter worked on Capitol Hill for then Congressman and now Senator Ron Wyden. She has broad campaign experience and has been deeply involved in Democratic politics since childhood. She has a master's degree in international studies from the University of Washington and worked as a writer, editor, and instructional designer at the UW from 1995-2006. She is currently a fellow at Daily Kos.

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  1. Joan, Not again. Healthcare “reform” has nothing to do with, well, healthcare. It’s designed to wreck the best medical care in the world. But I’ve already commented on this ad nauseum (Joan, would you have some Alka Selzter or Tums?). Obamacare (and that’s what we’re talking about) is simply the best way for the hard Left to create a dependent misery class of everybody, and to make healthcare and it’s maintenance a campaign issue Chicago politics-style in every upcoming election cycle ad nauseum (please, Joan, that Tums).The Brits have been carrying on with this nonsense since 1948, and their National Health Service (NHS) is a wreck. Please see Mark Steyn’s cover story in the latest issue of National Review. As for Baucus, yes, I agree. He’s the Senate’s version of Mortimer Snerd (there’s a pop culture reference lost on most of your fan club). Anyway, BARF. Too late, Joan….Wait, I’ll be as serious as I can. Get government out of it. Period. Do you need trillion dollar legislation to buy a big screen TV? A washing machine or fridge? A car? Wait a minute. Scratch the last one. That’s a nightmare on the way too. Anyway, thumbsucker. Who cares about Baucus and Grassley and their parlor game? Sideshow.

  2. Max has been in the senate for so long he has forgotten what the average working many goes through to feed his family and provide health care. He has had the best health care policy available in the country while serving the interests of the insurance ‘industry’ and big pharma. Most of the people opposed to the public option are only concerned with the massive profits of the insurance ‘industry’ or they scream ‘socialism’ which is no argument at all. A for profit health care system is amoral at best and immoral at its worst!