For all the uncertainty surrounding health-care reform, most observers thought they could count on at least one thing from Capitol Hill that the proposals coming out of the House of Representatives would be bolder and more liberal than those from the more moderate Senate. But as the first details of the actual bills begin to surface, that's no longer so clear. On Tuesday, the same day that the Senate Health, Education, Labor and Pensions (HELP) Committee released some of its bill's language, the first outlines of the bill being drafted by the three key committee chairmen in the House Energy and Commerce's Henry Waxman, Ways and Means' Charles Rangel and Education and Labor's George Miller showed that while the two chambers are going along generally parallel tracks, it may well be the House that is taking the more cautious approach, at least for the moment. (You can read it here.) There are, of course, still a lot of details that have yet to be filled in, and much could change. But here are a couple of key policy areas that stand out:
The Public Plan. Yes, the House version has a government-run option, which Democrats say would be crucial to holding down costs and to provide competition that would, in President Barack Obama's words, "keep insurance companies honest," but which Republicans say would be a deal-breaker. Still, the House model appears to be far weaker than one described in early drafts of the HELP Committee's legislation. If those early drafts are any indication, the HELP version would look a lot like Medicare, with the rates that it reimburses hospitals, doctors and other health-care providers linked to those paid by the government medical plan for senior citizens, which generally run about 30% lower than what private insurers pay health providers. (However, the HELP version may well be in flux; a version of the legislative language filed Tuesday contained no mention of a public plan at all.) (Read "The Five Big Health-Care Dilemmas.")
The House version, on the other hand, would have a government plan that looks a lot like a private insurance company. "The public health insurance option is self-sustaining and competes on 'level field' with private insurers," according to the document released by the three committee chairmen.
That's a very big difference. Where the insurance industry says that it would go broke if it had to compete with a Medicare-like option, some of the big companies say privately they could live with a government plan, if it had to sustain itself (as they do) on the premiums they collect, and if it is subject to the same regulatory rules that they are. Similarly, the weaker House version would not run into as much opposition from hospitals and doctors, who don't want yet another government plan squeezing them the way that Medicare does. However, that kind of plan would disappoint many liberals, who had hoped that a muscular public plan might be the first step toward a national single-payer system, similar to that of Canada and Britain.