The Baucus bill is a good start in getting the nation to the goal of universal health care, but more tweaking is needed to make this bill true reform and to corral costs.

Another in a series of editorials on efforts to reform the nation's health care system.

Max Baucus accomplished at least two things as he nipped and tucked the health care bill his Senate Finance Committee will consider Tuesday.

First, the Montana Democrat bloodied almost every one of the nation's prominent health care interest groups; second, the committee produced the only bill that stands a fighting chance of attracting enough centrist Democrats to gain passage. Both are good things.

The Baucus bill would remake one-sixth of the nation's economy in an essential reform that is now closer than at any time since President Harry S. Truman ripped the "do-nothing 80th Congress" for opposing national health insurance in 1948.

If the bill survives the committee vote this week as expected, Senate Majority Leader Harry Reid (D-Nev.) will combine it with a version passed by the Senate Health Committee. Sen. Olympia Snowe of Maine is the only Republican who shows the slightest inclination to support the Baucus bill. Republicans are unlikely to support any of the three bills pending in the House.

Whether the GOP at large realizes it or not, the public is ready for change. Fifty-seven percent of Americans said that health care reform is "more important than ever," according to the Kaiser Health Tracking Poll released Sept. 29. And some prominent Republicans do seem to understand the need, including former Wisconsin Gov. Tommy Thompson, former Sen. Bill Frist of Tennessee and Gov. Arnold Schwarzenegger of California. All endorsed reform efforts in the past week.

But while the Baucus bill would do some good, it still needs tailoring. President Barack Obama should lobby Congress to ensure that only the best ideas emerge.

Our concerns:

--The bill does not create a government-run insurance plan to compete with private plans in the health insurance buying exchanges that would be created for those who are not covered by employer plans or other government programs. This is a major flaw. Health insurance premiums have risen between 88% and 145% in the past decade -- they are breaking the budgets of average working people. The average annual cost of a family health insurance plan is now $13,375, according to the Kaiser Family Foundation. Clearly, private insurers don't have enough competition.

But we're not convinced the bill's health insurance co-ops, adopted in lieu of a public plan, would do the job. Even the bill's language acknowledges that co-ops would not establish "a significant market presence in many areas."

A show of hands: How many of you are satisfied with the performance of your health insurer? OK, then why not ask the insurers to put more skin in the game? Millions of new customers will flow to insurers as a result of mandated coverage, which argues for some limit on how much private insurers should profit from that requirement.

--The bill could cost far more than Baucus is letting on. A Congressional Budget Office report, widely heralded last week, contends the bill would reduce the deficit by $81 billion over 10 years. The figure is illusory. The bill makes the bold assumption that Congress will actually do what it says it will do and reduce physician payments to Medicare providers by up to 25%. Don't hold your breath. If those reductions do not occur, and history argues that they will not, then the real cost of this bill will be billions of dollars more.

--The bill should do more to change the fee-for-service culture in health care that rewards volume over quality.

--Despite changes made to the bill recently, it's still unclear if the working poor will be able to afford insurance through the exchanges -- even with subsidies. And even after spending more than $800 billion, the bill would leave 25 million uninsured by 2019.

A good start

Despite its flaws, though, the Baucus bill represents progress. It is not so much health care reform as it is insurance reform. But that's a start and lays a foundation for future work.

The bill would cover 94% of Americans; about one-third of those remaining on the sidelines would be illegal immigrants. It envisions innovative approaches to reduce costs, including creation of an independent commission with real teeth that would remove Medicare pricing from the influence of special interests that each year badger Congress into spending far more than is necessary for quality care. And it would allow insurers to sell across state lines, which under tight regulation should help drive down premiums.

The bill would tax Cadillac health care plans, which has the twin benefit of raising revenue to pay for subsidies for low-income people and discouraging companies from offering plans that waste medical resources. It extracts new fees from Big Pharma and medical device makers and ends the debilitating practice of denying coverage for pre-existing conditions.

The bill is expensive -- costlier than it seems at first blush -- but the cost of inaction would be higher. Health care costs are rising at an alarming rate as the number of uninsured in America approaches 50 million. There are many arguments in favor of fixing this broken system: It kills jobs; puts unacceptable burdens on family budgets; allows well-heeled corporate titans, such as the insurance companies and big pharmaceutical firms, to gouge hard-working Americans.

But the best argument remains: The world's richest nation simply shouldn't allow millions of its people to teeter at the edge of financial ruin, just one accident or one bad gene away from disaster.

Fix the Baucus bill, pass it and begin to fix the system.

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