A little more than a week after the election and 10 weeks before a new congressional session begins, an influential senator has launched the debate on overhauling the U.S. health care system—keeping employers at the heart of coverage for most Americans.

Sen. Max Baucus, D-Montana and chairman of the Senate Finance Committee, introduced a plan Wednesday, November 12, that he said would guarantee health insurance to every American while reducing costs and improving quality of care.

Employers that do not offer a health plan would have to contribute to a fund to help cover the uninsured.

With the economy headed into a recession—or already there by some estimates—President-elect Barack Obama and Congress will have plenty of issues competing for the top of the agenda. Baucus urged Obama and his colleagues to turn to health care immediately.

“There’s no way to really solve America’s economic troubles without fixing the health care system,” Baucus said at a Capitol Hill press conference.

His goal is to have Congress vote on a health care reform bill by the middle of next year. “The need is so great, we need to act now with dispatch,” he said. “The longer the inaction, the greater the cost.”

Baucus has not yet offered legislation. He said he would work with the Senate Health Education Labor and Pensions Committee in crafting a bill. The chairman of the HELP panel, Sen. Edward Kennedy, D-Massachusetts, has been assembling a comprehensive health care reform proposal for months.

Baucus’ plan “provides an important analysis of the urgent need for significant improvements in our health care system and thoughtful recommendations for reform,” Kennedy said in a statement.

Universal coverage is the key to Baucus’ initiative. Getting “everyone under the tent for health coverage” will lead to lower premiums, improved insurance markets and more effective preventive medicine, Baucus said.

Baucus would establish a nationwide Health Insurance Exchange in which people could purchase plans. Companies that don’t cover their employees would have to pay into an insurance pool. Low-income families and small businesses would receive premium subsidies.

Unlike Obama, Baucus favors an individual coverage mandate.

“Much of what’s here dovetails with the president-elect’s own health plan,” Baucus said. “Where we differ, I have committed to work with him to find consensus. For this to work, every American has to be included.”

There won’t be spending estimates for the Baucus plan until it becomes a bill. Baucus acknowledges that it will cost more than it saves for a number of years. That may draw opposition from Republicans and conservative Democrats, as Baucus tries to build bipartisan consensus.

He also will have to find common ground with the other side of Capitol Hill. Rep. Fortney “Pete” Stark, D-California and chairman of the House Ways and Means Health Subcommittee, predicted that Congress would take smaller steps toward health reform, such as expanding the State Children’s Health Insurance Program, which President Bush vetoed, and implementing nationwide standards for health care information technology.

In a news conference Monday, Stark predicted that the House would wait for Obama to send health care legislation to Congress and then would proceed with hearings.

Although the legislative direction won’t crystallize for a while, it looks as if the increased Democratic majorities in Congress don’t portend a government-run health care system.

Instead, Baucus, a centrist Democrat, and Stark, a liberal, agree that that companies should continue to play a central role in providing health care.

“Eliminating employer-based coverage, as some have proposed, would upend health care for more than half the American people—158 million in all,” states Baucus’ plan, “Call to Action: Health Reform 2009.”

Baucus said that “nothing is off the table” in the health care reform debate, but he added, “I don’t think the single-payer system makes sense in this country.”

Stark said that with business groups like the U.S. Chamber of Commerce calling for health care changes “there’s a much broader constituency for reform” than there was in the early 1990s when the Clinton administration attempted to pass a comprehensive plan.

But he cautioned that Americans don’t want to lose their company coverage.

“You’d start a revolution overnight,” Stark said. “People won’t change that radically or that rapidly. [Reform] will have to involve current types of insurance programs. We might come to an all-payer system.”

Baucus wants his plan, which is based on a series of Finance Committee hearings over the summer, to be the foundation. “Change is coming,” he said. “This is where I believe we should start.”

—Mark Schoeff Jr.

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