Poll Finds Most Doctors Support Public Option

Majority Of Physicians Want Public And Private Insurance Options

Notes

The survey was designed and conducted by Drs. Salomeh Keyhani and Alex Federman of Mount Sinai School of Medicine. Over the summer of 2009, they surveyed a random sample of more than 2,000 physicians.

Credit: Alyson Hurt / NPR

As A Public Option, Doctors Don't Mind MedicareSep. 14, 2009

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September 14, 2009

Among all the players in the health care debate, doctors may be the least understood about where they stand on some of the key issues around changing the health care system. Now, a new survey finds some surprising results: A large majority of doctors say there should be a public option.

When polled, "nearly three-quarters of physicians supported some form of a public option, either alone or in combination with private insurance options," says Dr. Salomeh Keyhani. She and Dr. Alex Federman, both internists and researchers at Mount Sinai School of Medicine in New York, conducted a random survey, by mail and by phone, of 2,130 doctors. They surveyed them from June right up to early September.

Most doctors — 63 percent — say they favor giving patients a choice that would include both public and private insurance. That's the position of President Obama and of many congressional Democrats. In addition, another 10 percent of doctors say they favor a public option only; they'd like to see a single-payer health care system. Together, the two groups add up to 73 percent.

When the American public is polled, anywhere from 50 to 70 percent favor a public option. So that means that when compared to their patients, doctors are bigger supporters of a public option.

Doctors' Support For Public Option 'Broad And Widespread'

The researchers say they found strong support for a public option among all categories of doctors. "We even saw that support being the same whether physicians lived in rural areas or metropolitan areas," says Federman.

"Whether they lived in southern regions of the United States or traditionally liberal parts of the country," says Keyhani, "we found that physicians, regardless — whether they were salaried or they were practice owners, regardless of whether they were specialists or primary care providers, regardless of where they lived — the support for the public option was broad and widespread."

EnlargeMario Tama/Getty Images

Doctors and other supporters of health care overhaul attend a candlelight vigil in New York City in September 2009. The gathering was one of hundreds nationwide honoring those suffering under the current health care system.

Keyhani says doctors already have experience with government-run health care, with Medicare. And she says the survey shows that, overall, they like it. "We've heard a lot about how the government is standing in between patients and their physician," Keyhani says. "And what we can see is that physicians support Medicare. So I think physicians have sort of signaled that a public option that's similar in design to Medicare would be a good way of ensuring patients get the care that they need."

The survey was published online Monday by theNew England Journal of Medicine. It was funded by the Robert Wood Johnson Foundation, a health care research organization that favors health reform.

AMA Doctors Also Support Public Option

The survey even found widespread support for a public option among doctors who are members of the American Medical Association, a group that's opposed to it. The AMA fears a public option eventually could lead to government putting more limits on doctors' fees.

"The American Medical Association has traditionally been probably the loudest voice for physicians across the United States," says Federman. "And part of our reason for doing this research was really to get at the real voice of physicians as opposed to the voice of one physician organization."

Keyhani and Federman belong to another, smaller group, the National Physicians Alliance. It supports a public option, and Keyhani has spoken publicly about her own support for a public option.

What Would A Public Option Look Like?

It's hard to know for sure what doctors mean when they speak about a public option, says Dr. James Rohack, president of the AMA.

"Because when I say public option, or you say public option, it means different things to different people, kind of like the Rorschach ink blot test — when you look at it, to some people it means one thing, to other people it means the other thing."

Politicians in Washington turn to the AMA for support and guidance, even though fewer than a third of practicing doctors belong to the lobbying group.

The AMA's own position on a health overhaul has, at times, been hard to pinpoint. In July, it praised the bill that came out of the House of Representatives. That bill included a public option. But the AMA made it clear that what it really liked was that it eliminated cuts in doctors' fees from Medicare.

"And so I think that's why we need to be very clear about what does the AMA articulate for," says Rohack. "It's to make sure that everyone has coverage that's affordable, that's portable and that is quality — that is, it covers the things you need to cover because you've got a medical condition or developed a medical illness."

Poll Finds Most Doctors Support Public Option

How Does the Quality of U.S. Health Care Compare Internationally?

By: Docteur E and Berenson RA

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Faced with the prospect of the first major national health reform initiative in 15 years, America’s airwaves are filled with increasingly raucous debates about the pros and cons of ideas being proposed in Washington and on editorial pages across the country.

A common theme is how the U.S. health care system stacks up when compared to the rest of the world and the impact that reform could have on it. Recent surveys show that the majority of Americans believe that despite spotty coverage, high costs and other problems, the U.S. health care system—and the quality of health care delivered—is the best in the world. But is it really?

An analysis from the Urban Institute looks at the evidence on how quality of care in the United States compares to that in other countries and provides implications for health reform. Authors Elizabeth Docteur and Robert Berenson find that international studies of health care quality do not in and of themselves provide a definitive answer to this question.

What they do show is that the evidence for American superiority in quality of care (or lack thereof) is a mixed bag, with the nation doing relatively well in some areas—such as cancer care—and less well in others—such as mortality from treatable and preventable conditions.

And while evidence base is incomplete and suffers from other limitations, it does not provide support for the oft-repeated claim that the “U.S. health care is the best in the world.” In fact, there is no hard evidence that identifies particular areas in which U.S. health care quality is truly exceptional.

Addressing the American public’s widespread concern about the potential negative impact of health reform on the quality of care they currently receive, the authors conclude that reform should in fact be seen as an opportunity to systematically improve quality of care, rather than a threat to the existing system. It provides an opportunity to build on strengths and correct weaknesses in U.S. health care, working towards aims for improvement that the care provided is safe, effective, patient centered, timely, efficient and equitable.

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• How Does the Quality of U.S. Health Care Compare Internationally?
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Physician Views on the Public Health Insurance Option and Medicare Expansions

Robert Wood Johnson Foundation survey shows physicians support reform plan that includes both public and private options.

By: Keyhani S, Federman A and Robert Wood Johnson Foundation

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A RWJF survey summarized in the September 14, 2009 edition of the New England Journal of Medicineshows that 62.9 percent of physicians nationwide support proposals to expand health care coverage that include both public and private insurance options—where people under the age of 65 would have the choice of enrolling in a new public health insurance plan (like Medicare) or in private plans. The survey shows that just 27.3 percent of physicians support a new program that does not include a public option and instead provides subsidies for low-income people to purchase private insurance. Only 9.6 percent of doctors nationwide support a system where a Medicare-like public program is created in lieu of any private insurance. A majority of physicians (58%) also support expanding Medicare eligibility to those between the ages of 55 and 64.

In every region of the country, a majority of physicians supported a combination of public and private options, as did physicians who identified themselves as primary care providers, surgeons, or other medical subspecialists. Among those who identified themselves as members of the American Medical Association, 62.2 percent favored both the public and private options.

The survey was conducted between June 25 and September 3, 2009 by Salomeh Keyhani, M.D., M.P.H., and Alex Federman, M.D., M.P.H., of the Mount Sinai School of Medicine in New York City. While the survey was conducted in several “waves” over a tumultuous summer for the health reform debate, no statistically significant differences were identified in physician responses throughout the summer.

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• Physician Views on the Public Health Insurance Option and Medicare Expansions: Full Report
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Doctors on Coverage — Physicians’ Views on a New Public Insurance Option and Medicare Expansion

Salomeh Keyhani, M.D., M.P.H., and Alex Federman, M.D., M.P.H.

In the past few months, a key point of contention in the health care reform debate has been whether a public health insurance option should be included in the final legislation. Although polls have shown that 52 to 69% of Americans support such an option,¹ the views of physicians are unclear. Physicians are critical stakeholders in health care reform and have been influential in shaping health policy throughout the history of organized medicine in the United States.²

The voices of physicians in the current debate have emanated almost exclusively from national physicians’ groups and societies. Like any special-interest group, these organizations claim to represent their members (and often nonmembers as well). The result is a well-established understanding of the interests of physicians’ societies but little, if any, understanding of views among physicians in general. Faced with this absence of empirical data, we conducted a national survey of physicians to inform federal policymakers about physicians’ views of proposed expansions of health care coverage.

In April 2009, we obtained data on a random sample of 6000 physicians from the American Medical Association (AMA) Physician Masterfile, which includes current data on all U.S. physicians. We excludedphysicians from U.S. territories because health care reform may not be as relevant to them, and we excluded physicians in training because of their limited experience with insurance; a sample of 5157 physicians remained. We categorized physicians into four groups: primary care physicians (in internal medicine,pediatrics, or family practice); medical subspecialists, neurologists, and psychiatrists; surgical specialists and subspecialists; and other specialties. The survey instrument we used was developed with the input of an expert panel, and we conducted cognitive testing and pilot testing to ensure its clarity and relevance. (More detailed information about our methods can be found in the Supplementary Appendix, available with the full text of this article at NEJM.org.)

Survey respondents were asked to indicate which of three options for expanding health insurance coverage they would most strongly support: public and private options, providing people younger than 65 years of age the choice of enrolling in a new public health insurance plan (like Medicare) or in private plans; private options only, providing people with tax credits or subsidies, if they have low income, to buy private insurance coverage,without creating a new public plan; or a public option only, eliminating private insurance and covering everyone through a single public plan like Medicare. We also assessed the level of physician support for a proposal that would enable adults between the ages of 55 and 64 years to buy into the current Medicare program — a strategy that the Senate Finance Committee has proposed.

Data were also collected on additional variables that might be associated with preferences for different expansion options, such as time spent on clinical duties each week, whether physicians owned their own practice, salary status, and type of practice. The survey has been in the field for approximately 2 months (June 25, 2009, to September 3, 2009). All available data were analyzed on September 4, 2009. A third survey wave was initiated on August 27, 2009.

The final sample included 5157 physicians, but 221 of them had an incorrect or incomplete address or were deceased. Of the remaining 4936 physicians, 2130 returned the survey — a response rate of 43.2%. Women made up a smaller proportion of respondents than of nonrespondents (26.8% vs. 31.2%, P<0.001), and the average age of respondents was 1 year older than that of nonrespondents. There were no significant differences associated with practice location (census division or urban vs. rural setting), practice type, or specialty group. There were no significant differences in the characteristics of respondents to different survey waves (for details, see the Supplementary Appendix).

Overall, a majority of physicians (62.9%) supported public and private options (see Panel A of graph). Only 27.3% supported offering private options only. Respondents — across all demographic subgroups, specialties, practice locations, and practice types — showed majority support (>57.4%) for the inclusion of a public option (see Table 1). Primary care providers were the most likely to support a public option (65.2%);among the other specialty groups, the “other” physicians — those in fields that generally have less regular direct contact with patients, such as radiology, anesthesiology, and nuclear medicine — were the least likely to support a public option, though 57.4% did so. Physicians in every census region showed majority support for a public option, with percentages in favor ranging from 58.9% in the South to 69.7% in the Northeast. Practiceowners were less likely than nonowners to support a public option (59.7% vs. 67.1%, P<0.001), style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; "> it. Finally, there was also majority support for a public option among AMA members (62.2%).

Physicians’ Support of Options for Expanding Insurance Coverage and Medicare.

Panel A shows the proportion of survey respondents who favored public options only, those who favored both public and private options, and those who favored private options only. Panel B shows the proportions of respondents (according to their medical specialty) who supported, opposed, or were undecided about the expansion of Medicare to include adults between the ages of 55 and 64 years. The proportion of support was consistent across all four specialty groups (P=0.08).

Forget the Goggles: Chlorophyll Eye Drops Give Night Vision

Seeing in the dark could soon be as easy as popping a pill or squeezing some drops into your eyes, thanks to some new science, an unusual deep-sea fish, and a plant pigment.

In the 1990s, marine biologist Ron Douglas of City University London discovered that, unlike other deep-sea fish, the dragonfish Malacosteus niger can perceive red light. Douglas was surprised when he isolated the chemical responsible for absorbing red: It was chlorophyll. “That was weird,” he says. The fish had somehow co-opted chlorophyll, most likely from bacteria in their food, and turned it into a vision enhancer.

In 2004, Ilyas Washington, an ophthalmic scientist at Columbia University Medical Center, came across Douglas’s findings. Washington knew that the mechanisms involved in vision tend to be similar throughout the animal kingdom, so he wondered whether chlorophyll could also enhance the vision of other animals, including humans. His latest experiments in mice and rabbits suggest that administering chlorophyll to the eyes can double their ability to see in low light. The pigment absorbs hues of red light that are normally invisible in dim conditions. That information is then transmitted to the brain, allowing enhanced vision.

Washington is now developing ways to deliver chlorophyll to human eyes safely and easily, perhaps through drops. He believes that a night-vision drug would be most useful on the battlefield, so it is no surprise that the U.S. Department of Defense is funding his work. “The military would want this biological enhancement so they don’t have to carry nighttime goggles” during operations in the dark, he says.

Vital Signs The Sneaky Pain That Fooled 6 Experts

Forty-two-year-old Russell McCoy was energized and sweaty as he finished a three-mile run around his neighborhood. He headed straight for his refrigerator and cracked open a diet soda, downing it in a couple of swigs. Holding the empty can, he backed toward the garbage pail, pivoted, shot, and scored. Then pain, sudden and excruciating, lanced through his left hip. He bent over, aware that he had twisted something the wrong way. Breathing deeply, he felt a little better. A few hours later, though, he tried to run a few strides and almost yelped from the pain. For the next two weeks, he took it easy. But the hip didn’t get better.

I first saw Mr. McCoy in June, two months after the soda-can episode. He had already been to another doctor, who was convinced this was “referred pain”—in other words, pain in one body area that is actually the result of a problem in another. According to that doctor, Mr. McCoy had strained his lower back muscles and was experiencing it as hip pain. A week of an anti-inflammatory medicine and stretching exercises for the lower back had not helped, however. An X-ray of the hip a month later showed no sign of arthritis or fracture, and an MRI of the lower back hadn’t revealed much either, just a small disk bulge that seemed unrelated to the pain.

Over the two months since the injury, my patient told me, he had gained 10 pounds. He wasn’t exercising because it hurt too much. He wasn’t sleeping well, either; the hip ached when he lay on his left side. He sucked his breath in sharply when I pushed on the greater trochanter, the bony outer part of his upper left thigh.

His main symptom—the sore spot on his hip that hurt when pressed—was typical for trochanteric bursitis, inflammation of the greater trochanter’s bursa. A bursa is a fluid-filled sac that allows adjacent tissues to glide over each other. When injury or overuse irritates the bursa, any pressure or movement around it will cause pain. I recommended treating the inflammation with a cortisone injection.

My patient cringed at the thought of a needle poking into the painful area. Instead, he decided to seek yet another opinion, this time from an orthopedic surgeon. Like the first doctor, the surgeon believed the symptoms originated in the lower back. He had Mr. McCoy see a physical therapist, who thought the back had nothing to do with it and that he had strained a muscle in his hip. The next stop was a chiropractor, who worked on both hip and back with no improvement.

Finally, four months after our first visit, Mr. McCoy was back in my waiting room. His belly now bulged over his belt, and he grimaced each time his left foot hit the floor. “I’m ready for the injection,” he said. “Let’s go for it.”

I had him lie on his right side, located the most tender area on the top of his left thigh, and injected a mixture of anesthetic and cortisone. Injections like these are among the few procedures that can give almost instant relief. The anesthetic numbs the sore area immediately, and the steroid kicks in within two days. If the anesthetic helped, it would support my diagnosis, and we could be pretty sure that the steroid would work. If the anesthetic didn’t help, then it probably wasn’t trochanteric bursitis after all.

I held my breath as he took a few steps. He winced. The injection had not worked.

It had been six months since Mr. McCoy first hurt his hip, and now we were right back where we started. I had run out of ideas. The physical exam, the X-ray results, and the injection had ruled out the common causes of hip pain—arthritis, bursitis, fracture, referred pain from the lower back—but he still couldn’t run. In many situations, the search for a cause of pain ends without an answer, and we change our focus to pain control. But I was not ready to give up.

Apologizing for adding yet another doctor into the mix, I suggested a rheumatologist—a joint specialist—who then sent Mr. McCoy for a procedure in which an anesthetic, followed by cortisone, was injected directly into the ball-and-socket part of the hip joint. This, too, failed to relieve the pain.

It had been six months since Mr. McCoy hurt his hip, and now we were back where we started. I had run out of ideas.

We had not yet addressed the slight disk bulge that appeared on the MRI of Mr. McCoy’s lower back. I didn’t think it was the culprit, but we had no other leads. Disk bulges are notoriously tricky to interpret because they are common in people both with and without pain; in fact, they appear on MRIs of people without back pain roughly 50 percent of the time. So it isn’t easy to decide whether a bulge justifies the discomfort, expense, and radiation exposure of additional tests, or even surgery.

Mr. McCoy’s neurosurgery appointment wouldn’t happen for another two months. While he waited, I suggested he return to the physical therapist for a cane and some hip exercises.

When I saw him a month later, in January, I had to blink a couple of times. He wasn’t limping. He wasn’t using a cane. He was smiling.

What he told me was so utterly unexpected, so simple, that I was at a loss for words. “I have a short leg,” he explained. “The physical therapist measured my legs, and my right one is about half an inch shorter. He gave me a heel lift and it’s working like a charm.”

I had not learned about leg length discrepancy (LLD) in my training, and it seemed that none of the other clinicians Mr. McCoy saw had considered it either. But leg length discrepancies are common. According to some studies, up to 70 percent of people have a slight difference in the length of their legs; one person in a thousand has a difference of nearly an inch. In most cases, the difference goes undetected.

There are two kinds of LLD. Structural discrepancies, which can be congenital or the result of a fracture or hip replacement surgery, involve an actual difference in the length of the bones. Functional discrepancies, on the other hand, are caused by muscle weakness or stiffness in the pelvis, ankle, or foot—the legs are the same size but function as if one is longer. Mr. McCoy probably had a lifelong mild leg length discrepancy that never bothered him until he hurt his hip. The pain changed the way he walked, and all of a sudden the discrepancy mattered.

My patient’s LLD was small enough that it had never caused an obvious limp, at least until now. But there was another clue that nobody had noticed. “I looked at the soles of his shoes, and one was more worn,” the physical therapist told me. “If the right leg is shorter, you tend to walk on the outer part of that foot, to extend the leg. On the other side, to make the longer leg feel shorter, you flatten out that foot. You can learn a lot from the soles.”

One common method used to check for a structural leg length discrepancy involves running a tape measure from a point on the pelvis to the ankle bone several times and then averaging the numbers. To check for a functional discrepancy, a physical therapist will measure from the belly button to each ankle bone. Some doctors recommend taking a special X-ray to verify the measurement; others believe that the degree of accuracy achieved with an X-ray is not worth the radiation exposure and is not necessary with small discrepancies.

Physical therapists often give a patient with hip pain and a small LLD a heel lift or even an insert from a sneaker to try for a week or so. What makes the treatment tricky is that a heel lift doesn’t always work. As with those incidental disk bulges on MRIs, a leg length discrepancy may have nothing to do with the pain; since a slight difference in leg lengths is so common, it would be easy to make the mistake of treating the pain with a heel lift when there is another reason for it, like arthritis or bursitis. And some people have had an LLD for so long that they’ve compensated by holding their pelvis at a certain angle. In those situations, a heel lift that is used for more than a week may end up causing pain rather than relieving it.

For some people, the search for relief from hip pain never ends. Luckily, that wasn’t the case with my patient. The heel lift did more than match the length of his legs. It lifted his spirits.

Anna Reisman is an internist in West Haven, Connecticut. The cases described in Vital Signs are real, but names and certain details have been changed.

Woman’s Blindness Cured By Tooth Implanted in Her Eye

Nine years ago, Sharron Thornton’s hair and nails fell out, while her skin developed a blistering rash. Turns out she was suffering from a very rare condition—know as Stevens-Johnson syndrome—caused by a reaction to a medication. She eventually went blind after the cells in her eye died and left corneal scarring.

While her hair and skin grew back, her eyes remained useless. Her condition devastated her: She thought about suicide, and tried a stem cell procedure, but couldn’t be considered for a cornea transplant. Finally she went on a desperate search for any experimental treatment to cure her blindness.

For the first time in the U.S., surgeons decided to perform a rare procedure called modified osteo-odonto keratoprosthesis, to correct corneal scaring. While the procedure has been done a total of 600 times since the 1980s, it’s still pretty complicated: First the surgeons took Thornton’s tooth and part of her jawbone, and made a hole for the prosthetic lens. Then it got weirder: The surgeons implanted the modified tooth into the woman’s chest and left it there for a few months so the two parts could grow together. And finally, the tooth was implanted into her eye.

CNN reports:

Dr. Ivan Schwab with the American Academy of Ophthalmology told CNN he believes the process is too difficult and the result too disfiguring. There are alternatives that are nearly as good, he added.

“We’ve known about the procedure since the ’80s. It’s been going on for a while,” he said. “We’ve viewed it with some skepticism. It requires a sizable team and several operations. It seems to be reasonably successful on the small numbers that have been done,” though it does bring some disfigurement.

Surgeons doubt the procedure will be common in the U.S. anytime soon. But for Thornton, it gave her a reason to live.

Breaking down the Baucus bill

By: Carrie Budoff Brown and Patrick O'Connor September 17, 2009 05:13 AM EST

Senate Finance Committee Chairman Max Baucus (D-Mont.) worked for months to find common ground with Republicans on health care reform — but when he released his long-anticipated proposal Wednesday, the real problem quickly came into focus. He set the stage for a titanic struggle within his own party. Reaction from congressional Democratic leaders was lukewarm to worse, progressives were downright hostile and Republicans were scornful of what they described as brazen government grab. But Baucus may have provided lawmakers with the only viable blueprint for winning support across Congress, because he sought to find elements that pleased all sides. “There are honest and principled differences on all of us working for reform, and this package may not represent all of our first choices,” Baucus said. “But at the end of the day, we all share a common purpose: that is to make the lives of Americans better tomorrow than they are today and to get health care reform done, which means the time for action is now.” The next challenge for Baucus and the Senate leadership is to get the bill out of the Finance Committee — but after that, Senate Majority Leader Harry Reid (D-Nev.) will need to merge the Finance bill with one approved in July by the Senate Health, Education, Labor and Pensions Committee. Even Reid, who has generally supported Baucus’s efforts, sounded less than pleased, saying he needs to be convinced the bill is right for Nevada on a proposed Medicaid expansion. House Speaker Nancy Pelosi (D-Calif.) dug in on the element dear to her liberal caucus — the public insurance option — and whacked the Baucus bill for shunning it. Baucus has made the challenge clear for Democrats, who now must choose between competing visions of health reform: an employer mandate versus fees on employers, a public insurance option versus nonprofit insurance cooperatives, and taxes on millionaires versus industry and people with expensive health care plans. The proposal capped months of closed-door discussions that, in the end, produced no immediate Republican support — and critical comments from negotiators Chuck Grassley of Iowa and Mike Enzi of Wyoming, both of whom complained about “artificial deadlines” from the White House and Democratic leaders to push through a bill, as Grassley said. Baucus put the cost of his bill at $856 billion. It would require nearly all Americans to carry insurance and employers to help cover the costs of providing government subsidies, while prohibiting insurance companies from dropping or denying coverage for people with pre-existing conditions. The Congressional Budget Office estimated the bill would cost $774 billion over 10 years and cover 94 percent of Americans. It would leave 25 million people uninsured in 2019 — a third of whom are illegal immigrants — compared with 17 million in the House bill. The analysis came in $82 billion lower than Baucus had thought it would, suggesting there could be room for senators to make adjustments. However, any expenses added to the bill must be offset with new revenue, making the task politically difficult. Another looming battle between Baucus and fellow Democrats is over how to pay for the bill — especially since the Finance bill came in at least $100 billion cheaper than the House bill. The House would pay for health reform in part by taxing high earners, families who make at least $1 million, but Baucus proposed an excise tax on insurers for their top-of-the-line plans. And Republicans think both plans cost too much. “Bipartisanship on Capitol Hill is the equivalent of a child looking for the unicorn,” Rep. Anthony Weiner (D-N.Y.) said, referring to the months of negotiations between Baucus and three Republican senators on the committee — none of whom has embraced his bill. Weiner, an outspoken defender of the public option, said the Baucus bill would be “dead on arrival” in the House — a far stronger claim than that of his party’s leaders in that chamber. “It has been said that the Senate is the cooling saucer of our democracy,” Weiner said. “At this point, it is more akin to the meat locker. ... The Senate proposal will not pass muster in the House.” But Baucus aides said there is plenty for progressives to like: tax credits to purchase insurance for families with incomes of $88,200 or less, immediate creation of a high-risk pool to provide coverage to the uninsured and people with pre-existing conditions, an expansion of Medicaid, and Medicare coverage for annual prevention and wellness checkups. “It is common sense. It is a balanced bill. It certainly is a bill that can pass,” Baucus said. “And the choice now is up to those on the other side of the aisle — if they want to vote for it or not.”