Max Baucus scored a big win for health-care reformers last week when he put together a reform plan that the CBO deemed as actually cutting the deficit over both the first and second decade. I think the score is a bit of a cheat—relying on Medicare cuts that are unlikely to actually pass to achieve savings—but at this point, the argument is moot: Somewhat technical arguments about CBO methodology aren't likely to make much of an impact.
But while the Baucus plan is a major step forward for reformers, it's not without problems. Indeed, Democrats seem unanimous only in agreeing that it needs work. All in all, 564 amendments were filed in hopes of changing the bill.
And it looks as if several of the key amendments coming from the left side of the aisle would all make the bill more expensive—and make it tougher to hold onto that shiny CBO score. According to Politico, requested changes include reducing the hardship exemption and raising the threshhold at which gold-plated health-care insurance would be taxed. In other words, they want to provide more assistance. But that makes the legislation cost more.
It remains to be seen how much these and other potential changes will alter the bill's final score. And then there's still the matter of combining the Baucus plan with other bills. Liberals are going to push for changes that add to the cost. Moderates are going to resist such changes. And the White House is going to push to keep the plan from heading back into deficit-raising territory: Obama's one firm commitment throughout the debate has been that he won't sign any plan that adds to the deficit. It's very nearly a Mexican standoff over spending—and balancing all of the competing concerns will be difficult, perhaps impossible.
It's already come at a cost: Other priorities, like cap-and-trade, are falling by the wayside, and whether or not reform passes, Democrats are going to face a tough election in 2010. Max Baucus may have found a path past the CBO, but it's not clear if enough of his fellow Democrats will be willing to follow him down it.