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DBL%20Hendrix%20small.png College chemistry, 1983

Derek Lowe The 2002 Model

Dbl%20new%20portrait%20B%26W.png After 10 years of blogging. . .

Derek Lowe, an Arkansan by birth, got his BA from Hendrix College and his PhD in organic chemistry from Duke before spending time in Germany on a Humboldt Fellowship on his post-doc. He's worked for several major pharmaceutical companies since 1989 on drug discovery projects against schizophrenia, Alzheimer's, diabetes, osteoporosis and other diseases. To contact Derek email him directly: Twitter: Dereklowe

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September 25, 2009

The Details of the Baucus Bill

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Posted by Derek

Since we were discussing the Baucus health care proposal here the other day, I thought that people would appreciate a chance to read through the provisions of the bill before forming an opinion of it.

Sorry! You can't. It's not online, and it won't even be online by the time the Finance Committee is through with it. Senator Baucus, though, would like you know know that it's because it's just too darn difficult to put it up.

So we'll just have to trust them. I suppose. We may get a chance to look things over before the House votes on anything. Unless some good reason comes up not to do that, of course. It has before.

Comments (23) + TrackBacks (0) | Category: Current Events | Regulatory Affairs


1. SRC on September 25, 2009 12:54 PM writes...

Now why would the peasants have any business reading this bill, assuming they can read? Their betters know ...uh...better than they do what's best for them. So just get back to work, OK? Someone's gotta pay for all this, ya know.

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2. barry on September 25, 2009 1:49 PM writes...

It is reported in today's New York Times that the Baucus bill would require that insurance exchanges would write policies for "all comers" as of 2013, regardless of prior conditions. The incentive will therefore be strong for me to carry the cheapest, skimpiest insurance package until I get hit by a bus/diagnosed with cancer, and then buy-up to a more comprehensive plan--and the insurer would be obliged to take me. Either the insurer would have to charge me a premium equal to my entire medical costs (effectively no insurance at all) or the Insurance exchange will go bust.
I don't pretend that SinglePayer is the only way forward, but this alternative doesn't even pass the giggle test.

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3. DH on September 25, 2009 2:53 PM writes...

Requiring coverage for all comers regardless of pre-existing conditions is preposterous, and completely contrary to the notion of insurance. As various bloggers have noted: "isn’t that like expecting a home insurance company to write a policy for fire after your house has already burned down?" (E.g., see

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4. Disagree on September 25, 2009 3:26 PM writes...

@DH. "Requiring coverage for all comers regardless of pre-existing conditions is preposterous, and completely contrary to the notion of insurance."

Preposterous, no. Both good business and compassionate, yes. It works perfectly well in Switzerland. All insurers are required to provide a minimum level of insurance with premiums only based on a person age, not a medical history. This actually creates competition and fair pricing for that minimum coverage (medical exams can be required for greater coverage). And avoids the current US issues that people that develop conditions and loose insurance aren't then hosed for life.

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5. SP on September 25, 2009 4:11 PM writes...

There is a pretty comprehensive minimum coverage requirement that will be in place as well, so people won't be able to just buy $5/month plans until they get cancer and then upgrade. Republicans, of course, are trying to weaken those minimum requirements, resulting in Debbie Stabenow (D-MI) saying, "Your mom!" to Jon Kyl (R-AZ):
Also, let's be clear here- what they're not posting is the legislative language, which there is no way in hell you or any of your readers will ever read. They will post the final "plain English" version that the committee votes on, then converts to legislative form. For an example of the difference, see here:
This was primarily a delaying tactic- the longer Republicans can push off the entire process, the more likely it is to fail because you start approaching midterm elections. Note that the Finance Committee has always worked this way- NEVER before has a committee bill been required to be converted prior to voting out:
Please don't fall for these gotcha games that the minority party is playing- they propose something that sounds reasonable until you hear what's really happening and what the precedent is.

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6. Las vegas on September 25, 2009 6:10 PM writes...

Opioid narcotics are effective for diseases such as chronic pain partially solved, medicines like Vicodin, Lortab, oxycodone, Lorcet are widely used in USA and Europe for medical specialists findrxonline according to the percentage of use of these drugs is very high in this part of the continent.

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7. metaphysician on September 25, 2009 10:12 PM writes...

#4- you miss the point. Unless the minimum level of coverage is extremely negligible in cost to the company, requiring they provide coverage to anyone breaks the concept of insurance. People have variable risk, and the government basically says "You are not allowed to take that risk into account."

If the insurance company *knows* they are going to be paying out for a specific person, then they aren't engaging in insurance anymore. They are engaging in charity. Which is exactly what it is, when the 30 year old new insuree with cancer pays the same rates as the 30 year old new insuree with clean health, yet receives in benefits the amount a cancer victim would expect.

( the fact that this minimum level of coverage may not, in fact, be enough, doesn't change the fact that the insurance company is being hosed )

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8. Anonymous38772901 on September 25, 2009 10:38 PM writes...

#6 (until the drug spam is deleted) "metaphysician" is half right. It isn't insurance anymore. However, it's not the insurance company that will be hosed. They will simply raise premiums so their income covers their overhead, profits, and money spent on their customers' medical care.

If the government taxes the utility company, your utility bills will go up. If they tax insurance companies, your premiums will go up. Mandates, such as prohibitions against excluding pre-existing conditions and requirements to take all who apply, are simply another form of tax levied upon the people by the government.

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9. Rev. Howard Furst on September 26, 2009 1:26 AM writes...

" Mandates, such as prohibitions against excluding pre-existing conditions and requirements to take all who apply, are simply another form of tax levied upon the people by the government."

Unless you or someone you love has a horrible chronic or subchronic disease; then it's a good thing. "It's only SOCIALISM!!1! if it benefits someone else", or some outside one's personal sphere. No easy answers, hence the Baucus travesty.

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10. AR on September 26, 2009 5:32 AM writes...

I don't get all this love for an industry that rewards those who find ways to deny claims, but, hey, who am I to question the motives of for-profit businesses?

Governor Schweitzer: 'when the world ends the cockroaches, coyotes and insurance companies will still be in business. Don't cry for them, Argentina.'

I wanted the public option so I am not happy with Baucus bill, either. Most disturbing is bill does nothing to tackle reason American health care is most expensive in world but ranked 35th in effectiveness.

Google and read Gawande article 'The Cost Conundrum' in the New Yorker.

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11. metaphysician on September 26, 2009 10:02 AM writes...

#9- Who says anything about liking the industry? I just don't think the solution consists of screwing them over, it consists of replacing a health insurance industry with a lack of said industry at all, rather than having the government take it over. Because the problem isn't private health insurance, its treating health care *as* insurance.

Also, I have always been and continue to be skeptical of those statistics. Not to mention, they ignore the fact that the US subsidizes foreign health care, by virtue of us paying prices for new drugs based at least vaguely on market forces, rather than "Sell it to us for the price we pick or we'll violate your patent and you lose everything" blackmail.

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12. SP on September 26, 2009 12:46 PM writes...

My previous comment had several supporting links but Derek has failed to approve it, so a few brief points about which people seem misinformed:
1) The think not being published is the legislative language, not the plain language bill. The Finance Committee has always voted on plain language bills and converted them later- this is the first time in history some has asked for the conversion first. The Republicans want to delay this to 2010, because the closer it gets to midterms the harder it will be to hold together a coalition.
2) The reforms would require a pretty comprehensive minimum package, so there would be no "$5/month" package that people could keep until they get switch. There are also the mandates to ensure people don't try to play the system. However, a mandate without a fall-back public option is asking for trouble because the industry could add whatever profit margin they wanted if there were no non-profit competition.
3) It is insurance- social insurance. If you require everyone to participate, then you're spreading the risk of incurring the costs of significant illness across society. We need to decide if we want out society to be one where the bad luck of getting cancer or hit by a bus should be something where people and their families are financially ruined, or if there should be some maximal pain you incur beyond which we say that society will collectively protect you.

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13. metaphysician on September 26, 2009 1:32 PM writes...

#11- what you mention on that last bit is called "Catastrophic care insurance." *That* can be legitimately handled as insurance, since not everyone gets cancer, etc.

However, that doesn't change the lack of any benefit to treating standard care as insurance, because there is no benefit to risk pooling. To use an example, if everyone has only a 1% chance of wrecking their car, needing $10K in repairs ( numbers invented ), then insurance means instead of everyone bearing the risk of $10K ( and either saving the resources on hand, or gambling ), the per capita cost can be reduced to $100. If everyone needs an average of $10K in medical expenses per year, however, then the per capita cost is. . . still $10K.

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14. SRC on September 26, 2009 6:54 PM writes...

Insurers want you to stay alive and paying premiums as long as possible, as healthy as possible, and then to die quickly and cheaply.

The government wants you to stay alive as healthy as possible, until you retire or otherwise stop paying premiums, then to die as quickly and cheaply as possible, because from then on you're a liability.

It's that simple. East Germany built the Berlin Wall to keep in the young and productive. They were happy to let the elderly leave. Liberals need to ask themselves: why? And how would government-supplied healthcare have a different incentive?

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15. Fausty on September 26, 2009 7:48 PM writes...

This is not about insurance. It's about the profits to be made from turning the 47 million uninsured into criminals.

This is the scam: Those people can't afford insurance now, and there's nothing in the proposed legislation which will drastically lower premiums (basically free). It stands to reason if they could afford health care, they'd buy it.

But there are many many prisons which will be built to house the 'health insurance evaders'.

Many lawyers will be hired to prosecute them.

Many police will be needed to round them up.

I find it funny that we're going to criminalize poverty. Right now any of you Yanks can drop out and live in a peat moss shack in the northern wilds should you choose.

But should you choose to return to society, you'll be smacked with thousands in back-dated health bills you never wanted and likely jail time.

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16. disagree on September 26, 2009 10:33 PM writes...

@metaphysician - I get the point quite well thank you. Yes, IT IS insurance. You pay money against the possibility of having more costs than your payment during the year, with the risk of having less costs than your payment each year. Sounds like insurance to me. The average yearly cost is never $10K, significantly less. So your minimum annual premium is greater than the average annual cost.

And NO, it isn't a way to hose the insurance companies. There is no public subsidy for them (in CH), they are profitable doing this. If they weren't, don't you think they would have gone out of business a long time ago? Where there is subsidy is that the government pays the premium for those that can't afford it, but that makes no difference to the insurance companies. In fact, with everyone making insurance payments, they are really very happy.

While I am in rant mode, I'd also like to pick up your point about drug pricing. Its totally fair to charge more in the US than other countries. The FDA requires more stringent testing here than anywhere else, which costs more. You want more, you pay more for it, simple.

OK, done. tx for the debate :-)

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17. McChemist on September 26, 2009 10:59 PM writes...

Sorry! You can't. It's not online,

Is it going to deflate your rant a bit if someone actually posts a link to the Baucas bill somewhere in this thread? I sure hope so!

Link to the plain language text of America's Healthy Future Act of 2009 (aka the Baucas bill).

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18. SRC on September 27, 2009 12:09 PM writes...

Great, McChemist. Now why can't they put the actual, binding, legal text there too? The Cliff Notes version is great, but irrelevant: it's the legislative version that will be legally enforceable - and enforced - and therefore the one that is operative.

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19. SP on September 27, 2009 1:49 PM writes...

Because, as I say above (see the most recent Ezra Klein post for another explanation), 1) it takes 3 weeks to convert it to legislative language, 2) Never before in the HISTORY of the finance committee have they written the legislative language prior to the committee vote, and 3) You won't understand the legislative version anyway- it makes all kinds of cross references to other pieces of the US Code it's amending, unless you're sitting there with the entire law book you're not going to make any sense of it. The people who convert it to legislative language are required to make it match the plain English bill that is passed, so all these complaints about "we don't know what's really being voted on" are crap. This is just a delaying tactic, don't fall for the BS.

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20. SRC on September 27, 2009 10:37 PM writes...

So you're saying you're too stupid to understand it?

I accept that explanation.

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21. SP on September 27, 2009 11:38 PM writes...

Spoken like a true wingnut. Now you're supposed to accuse me of being a socialist Hitler.

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22. Jose on September 28, 2009 4:45 AM writes...

Off-topic, but I am ecstatic to see an ad in the newest C&EN for a webinar entitled "Outsourcing is a Key Pathway in the Future of Drug Discovery." Sponsors include a trifecta of brilliance- Merck, AMRI, and last but not least, the ACS. Boy! I am so glad that I paid my dues so I can help some MBA more effeciently oursource my job.

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23. wgc on September 29, 2009 2:41 PM writes...

"Its totally fair to charge more in the US than other countries. The FDA requires more stringent testing here than anywhere else, which costs more. You want more, you pay more for it, simple."

Is this really true? Is a 10 mg pill of any prescription drug (Lipitor, for example) from Canada made to different specifications than the same dosage of the same drug from the same company in the US? If the pills in Canada are really of a lower quality, as asserted by anti-drug importation lobbyists, why aren't the Canadian health officials screaming?

And, do Pfizer, Merck, etc. have to repeat the clinical studies in each country? I do understand that some drugs are licensed for use in one country, but not in another, but these are different drugs.

I'm talking about the real thing you would get by prescription in both counties, not one of the internet spam sites that we all get emails from.

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