The odds are high that the excise tax will never actually happen. There is no reason to think that the Congress of 2018 will be any braver than the Congress of today. It will probably get around the pay-go rules or whatever else might apply and it’ll postpone the tax again. The excise tax will turn into another “doc fix.” This is a mythical provision in which doctors are always about to get their reimbursements cut. But somehow they never do because the cuts are always pushed back, year after year.
So we’ve sunk another level in our tawdry tale. The White House, to its enormous credit, has tried to think about the long term. But it has been dragged ever lower into the mire by Congressional special interests that are parochial in the extreme.
This bill may be deficit-neutral on paper. But it has just become a fiscal time bomb. The revenue will never come. Compromises have to be made to keep it (barely) alive. But responsibility ebbs. Politics wins.
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