I get it. The progressives who dominate the House leadership are absolutely committed to insuring more people, as many as they can. However, like David Brooks I wish they had the same sense of moral urgency about paying for it:
They’re going through the motions. They’ve stuffed the legislation with gimmicks and dodges designed to get a good score from the Congressional Budget Office but don’t genuinely control runaway spending.
There is the doc fix dodge. The legislation pretends that Congress is about to cut Medicare reimbursements by 21 percent. Everyone knows that will never happen, so over the next decade actual spending will be $300 billion higher than paper projections.
There is the long-term care dodge. The bill creates a $72 billion trust fund to pay for a new long-term care program. The sponsors count that money as cost-saving, even though it will eventually be paid back out when the program comes on line.
There is the subsidy dodge. Workers making $60,000 and in the health exchanges would receive $4,500 more in subsidies in 2016 than workers making $60,000 and not in the exchanges. There is no way future Congresses will allow that disparity to persist. Soon, everybody will get the subsidy.
There is the excise tax dodge. The primary cost-control mechanism and long-term revenue source for the program is the tax on high-cost plans. But Democrats aren’t willing to levy this tax for eight years. The fiscal sustainability of the whole bill rests on the naïve hope that a future Congress will have the guts to accept a trillion-dollar tax when the current Congress wouldn’t accept an increase of a few billion.
There is the 10-6 dodge. One of the reasons the bill appears deficit-neutral in the first decade is that it begins collecting revenue right away but doesn’t have to pay for most benefits until 2014. That’s 10 years of revenues to pay for 6 years of benefits, something unlikely to happen again unless the country agrees to go without health care for four years every decade.
There is the Social Security dodge. The bill uses $52 billion in higher Social Security taxes to pay for health care expansion. But if Social Security taxes pay for health care, what pays for Social Security?
There is the pilot program dodge. Admirably, the bill includes pilot programs designed to help find ways to control costs. But it’s not clear that the bill includes mechanisms to actually implement the results. This is exactly what happened to undermine previous pilot program efforts.
I believe that more people should be able to get quality healthcare, too. But I’m convinced that if you hold the supply of healthcare constant and throw more money at it, not only are you being fiscally reckless, in all likelihood in the long run you’ll end up with less healthcare. Will less healthcare really help more people get quality healthcare? I’m not seeing it.
If you can pass a bill with 51 votes or if both parties participate in good faith, you need fewer gimmicks. When the excise tax kicks in, it should make it viable.
Steve
Does the evidence support that, Steve? To my eye it appears that more of the deal-making had to do with intra-party negotiations than with inter-party negotiations.
Do you really believe that Olympia Snowe was not participating “in good faith”? I think she was.
It was the deal making for the 58th-60th votes that ruined things. There were enough committed to people to pass a better bill at 55 votes than 60.
Steve
Timothy Noah doesn’t believe the excise tax will kick in; it will simply be like the Alternative Minimum Tax or the Medicare reimbursement reductions. Once the tax starts to impact “regular” people, the pressure will be too great to readjust the tax for inflation.
To tell the truth, PD, many of my concerns about the present legislation would evaporate if the cost control mechanisms including the excise tax were to be implemented immediately. It would certainly be a test of the Congressional leadership’s bona fides.
However, my suspicion is that their support for healthcare reform would evaporate then, too.