So, yesterday, in the fog of a virus, I decided to print the Baucus bill and go through it closely.  I wanted to be informed, and in a sick perverted way, I like reading legislation.  For years I worked in Community Development and Affordable Housing, so trudging through law and regulations came with the territory.  

Since we are in the new age and we as citizens need to forage for information I wanted to share with you guys a few practical ways to look at public policy.  It seems that we rely on our modern day priests, the pundits and journalists,  to read and decipher the tablets with the laws from the gods.  

Yet, in these days, when information is available, we can spend sometime getting the first hand, not the priests version, of the tablets.   

I considered printing the House bill, but after I realized it was over 1,000 pages, I lamented the paper that I would be wasting.  The Baucus act, the America's Healthy Furute Act of 2009, is 200 plus pages.

 I then went to the Kaiser Family Foundation and found a side by side comparison of both bills and the President's position, I found their whole site to be very useful.  If you want to get some first hand education, I recommend this site, so when you read others, you have some first hand information.  

In public policy I tend to like elegant and simple solutions .  Lets say your goal is providing affordable healthcare, if I was doing it, this is what I ask the following questions:   

1.  Do we have an existing delivery system that will need no start up time and is ready to go?  (Medicare)

2.  Is that system cost effective? 

3.  Will the new system create new complexity that will burden the delivery?  

4.  Are you trying to solve more than one public purpose with the policy? Are you losing sight?  

5.  Are you creating something that you expect to improve later and just proposing something for now?  Is this "good" thing going to become an industry that then will fight to sustain itself?  

6.  Is the policy basically a series of market tweaks that you think will result in your goal, in this case, affordable healthcare for all Americans?   Is it just a major tweaking of tax and other policies and a pile of nuance and regulatory intricacy?  

With these questions in mind, I tried to trudge through the Baucus Act.  Acutally, it's not a bill right now, it's Mark up, or recommendations for discussion.  

After the  law/Act is passed, then the Department's responsible for implementing the Act, are required to issue Regulations and Procedures.  The regulations will be available for public comment and they are basically an interpretation of how the law will be implemented.   So, in truth, this is not the end, there will be further tomes that will be written and argued.   

What I always think when I read a bill that has a great deal of complexity, how will humans implement this beast?  How will they be able to enforce it and explain it to the end user:  You and me.   

I highly recommend the Kaiser site for an overall great and informative overview.  I am still reading the darn things and my love for this sort of thing is waning quickly.  

All the  current bills have the similar components.  You hear and read about dribs and drabs from here and there, but it's good to have a handle on what is the scope of the law and how it will be realized.   

Finally, I advise you to see what parts affect you and your family.   

1.  Individual Mandate:  the common theme is that we will be required to carry health insurance.  Each of the bills has various exclusions, whereases, buts and ifs.  (This is critical, the bills provide for subsidies to families at certain percentage above the National Poverty level not regional income levels) 

2.  Employer Requirements:  they all basically have a component that specifies what are the employer responsibilities, by size of business etc.  

3.  Expansion of Public Programs:  They each expand Medicare/Medicaid to the lowest income population.  

4.  Premium subsidies to individuals:  this is the critical section that will matter to you.  Based on income they each propose either a direct subsidy or a tax credit etc.  

5. Premium subsidies to employers:  Since employers will be required to provide insurance there are provisions for that.  

6.  Tax implications, there are various aspects that will affect your taxes and corporate taxes.  (psst, this is where they sneak in the stuff that they can claim does not increase taxes or is neutral to the budget; eyes glaze over but there is I assure you a cadre of the most clever tax attorneys creating a cottage industry right now).  

7.  The Insurance pooling mechanisms:  This is where the whole market vs. public argument lies.  This is where the cooperatives and gateways are.  This is where the insurance industry tweaking is.  Talk about going goofy reading stuff.  

8.  Benefits:  What in god's name will be and will not be covered?  

9. Changes in the private insurance industry:  what are the proposed regulatory changes (portability, precondition exclusions).  

10.  State roles:  This is important, the Baucus bill dumps a lot to the states through Medicaid without giving them money, watch the governors on this one, I don't blame them, the euphemism is "shared responsibility".  

11.  Cost containment:  simplification of regs, shared information etc.  This is where we wanted to see that we the people would get to negotiate the prices with big Pharma etc.  This is where the cost savings in Medicare were going to come from to help subsidize the premiums.  This is where the Pharmas have a big stake.  

12.  Finally we get to the last bits, how to improve how we deliver healtchare.  For example, people having primary doctors, evaluation and tracking of patients and policies.  

13. Prevention/ Wellness :  education, behavior change.  You know all that good stuff.  

14.   Long term care:  creating some affordable long term voluntary health care program. 

So, if it is helpful, use this list of 14 categories to compare and contrast the bills.  Use the categories as a crib sheet when you read the various opinions.  

At this stage I find both bills violate my own personal standards for Public Policy best practices.  But, since I know I will never see those standards applied in my lifetime, I have to dig and look at what we have and how it will be implemented and what implications it will have on American households.   

To my friend Chris, who shares my fetish for this kind of stuff, lets sit down soon and do our own side by side of the bills, just like the old days.