The Lewin Group "Staff Working Paper" examining the feasibility of combining the Baucus health care proposal with Ron Wyden Healthy Americans Act is, on first glance, a bit puzzling. For those interested, the paper concludes that harmonization is, indeed, feasible. But that's not a particularly interesting result. It's like finding that you can change the plot of a book that hasn't been written yet. What's interesting about the paper, rather, is the political jockeying that birthed it.
If you talk to supporters of the Wyden plan about the continued role for the Healthy Americans Act, they tend to emphasize a pretty simple point: They've actually got legislation. Their bill has been written and rewritten. They have spent years working with the Congressional Budget Office to get the budget hawk's seal of approval. They have brought the legislation before academics and interest groups, before politicians and business leaders. They have heard concerns and incorporated new features. They have put in the hours. And it was hard, and it took time. But the work was necessary. And it is done.
The Baucus white paper, by contrast, is not done. It is, as Baucus frequently says, a preliminary document. But there is little time. Baucus and Kennedy have announced their intention to release legislation in June. That's three months. Three months to rebuild American health care. To work with the Congressional Budget Office. To write and rewrite the legislation to achieve a good budget score. To finish. What you hear from Wyden's supporters, then, is a very simple plea: Copy our homework. Cadge our work. Change what you want. Put your name on it. But use it. It is, after all, done.
This Lewin document is another way of making that argument. It attempts to show that the plans are fundamentally similar, though in fact, I think it shows rather the opposite. The final plan in this bill looks a lot like the Healthy Americans Act on the coverage side and a lot like Baucus on the delivery side. It attempts to show that they can be harmonized, and sort of succeeds, but it elides the fact that if Baucus had wanted to release something that looked like the Healthy Americans Act, he just would have done so in the first place. It exists, however, so supporters of the Healthy Americans Act can point to a physical document showing how easily their scored, complete proposal could fit back into the process, and solve a number of cost and coverage problems to boot. It's a step forward in their argument. Last week, they were saying, "use us." This week, they're showing how to do it.
Lastly, the Lewin document included an admirably clear side-by-side comparison of the coverage structure in the two proposals. I've broken it out and uploaded it as a jpg here.