Another week, another “scoring” of a bill that (a) looks nothing like what it’ll look like in its final form and (b) almost certainly has been crafted to hide certain key costs (a la “doctor fix” in the House bill) to improve its “score.” Realistically, the only time a CBO score matters is when it’s bad: Were this to come in at over $900 billion or be judged a deficit-buster over the long term, it would be rejected for failing to meet the White House’s baseline demands. But this one just makes the cut, so look for the obligatory back-pat in this weekend’s presidential message about it being a “fine starting point” or an “encouraging beginning” or whatever. Reid managed to come up with a bill that isn’t too expensive … for Barack Obama. Congratulations.
Reid’s proposal would cover an additional 31 million people by 2019, according to a senior Democratic aide, who quoted a preliminary estimate of the legislation by the nonpartisan Congressional Budget Office. That would boost the percentage of non-elderly Americans with medical insurance from 83% to 94% over the next decade, slightly lower than the 96% that the CBO estimated would be covered by the healthcare bill that House Democrats passed last week.
Reid’s legislation which differs in important other ways from the House bill would also cost less, committing the federal government to $849 billion in new spending to expand coverage over the next decade, the aide said.
That would be offset by a combination of cuts in federal Medicare spending and a series of new taxes on healthcare industries and on wealthy Americans, including a hike in the payroll taxes that upper-income workers pay for Medicare.
The offsets mean that over the next 10 years, federal deficits would be $127 billion lower than they would without a healthcare bill, the aide said the Congressional Budget Office estimated. Deficits would be reduced by a further $650 billion in the next decade.
$127 billion over 10 years sounds like a lot until you remember that $176 billion was October’s monthly deficit. A decade of projected ReidCare savings was wiped out in less time than it took to start and finish this year’s baseball postseason. And this is all premised, of course, on those projections being accurate. Which, according to no less than the dean of Harvard Medical School, they surely aren’t:
In discussions with dozens of health-care leaders and economists, I find near unanimity of opinion that, whatever its shape, the final legislation that will emerge from Congress will markedly accelerate national health-care spending rather than restrain it. Likewise, nearly all agree that the legislation would do little or nothing to improve quality or change health-care’s dysfunctional delivery system. The system we have now promotes fragmented care and makes it more difficult than it should be to assess outcomes and patient satisfaction. The true costs of health care are disguised, competition based on price and quality are almost impossible, and patients lose their ability to be the ultimate judges of value.
Worse, currently proposed federal legislation would undermine any potential for real innovation in insurance and the provision of care. It would do so by overregulating the health-care system in the service of special interests such as insurance companies, hospitals, professional organizations and pharmaceutical companies, rather than the patients who should be our primary concern.
In effect, while the legislation would enhance access to insurance, the trade-off would be an accelerated crisis of health-care costs and perpetuation of the current dysfunctional system—now with many more participants. This will make an eventual solution even more difficult. Ultimately, our capacity to innovate and develop new therapies would suffer most of all.
One other fact to chew on: The $210 billion in hidden “doctor fix” costs contained in the House bill has no counterpart in the Senate, which killed a “doctor fix” proposal of its own last month. Guess whose side the White House is on.