Bob Laszewski and Richard Eskow, two health policy thinkers who I respect very much, have come to opposite conclusions on the Baucus plan. Eskow says that the plan shows the glimmers of an emergent consensus on health reform. Lazewski says that the plans is so vague on key elements like subsidy levels and the definition of "affordability" that is shows how little consensus there is. I'm closer to Eskow, but I think both are missing the point. The Baucus plan demonstrates some consensus on the broad outlines of health reform, but Laszewski is correct that the specifics are tabled for another day. Which might, indeed, be the relevant consensus position. One of the Baucus plan's embedded assumptions is that Congress should not define too much. In this, it's taking a page from the successful passage of the Massachusetts reforms, which offloaded a series of thorny questions -- including the definition of "affordability" and the specific premium subsidies -- on the Connector Authority. And sure enough, Baucus's plan has a variant of the Connector Authority in the Independent Health Coverage Council (more on that here and here). And the plan specifically leaves these questions up to the Council. So where Laszewski sees policy discord, I'm seeing political consensus. And the consensus, shared by Daschle and Baucus and Kennedy (whose health policy adviser, John McDonough, was deeply involved in the Massachusetts health reforms), is that Congress can only make so many tough decisions. And that the path of wisdom might be to make one tough decision that would create a legitimate, politically insulated body better able to make the rest of the tough decisions.
