Suderman buries the lede: Does the CBO analysis of the Senate health bill --the one that shows a 10-year deficit reduction of $132 billion--really assume that the scheduled reduction in doctor's payments of 21 % will actually go into effect- even though everyone knows Congress plans a "doctors' fix" to sharply reduce the cut, if not eliminate it entirely, in separate legislation . That's what Reason 's Peter Suderman alleges , and it appears that he's right. (See pages 13 and 18 of the CBO's report .)
I originally assumed this omission wasn't a major flaw, since the CBO was comparing a baseline in which doctor's fees were cut 21% with a health care reform in which they were also cut by 21%. A "doctors' fix" is going to happen, but the question was whether health care reform will make things better or worse apart from that "fix"--or from anything else, like an expensive new jet fighter, that could increase the federal budget. The "fix" could safely be ignored and treated as a separate issue.
But the more you think about it, the more the issues aren't separable. What if the docs get their "fix," their rates stay the same or rise, and this somehow affects the whole Medicare cost structure--indeed the whole medical cost structure--in ways that make the Senate bill relatively more expensive than the status quo (for example, by inflating the cost of all the free health care that would be provided under Medicaid, and the cost of all the extra health care that would be sought by newly insured Americans?) You'd want the CBO to at least think about that possibility, no?
As Suderman notes, taking the doctor's fix out of the bill was one of the key moves Democrats made to make health care reform appear more deficit-friendly. It seems less corrupting than back-loading the bill's spending (which they also did). But it may have been a more corrupting move than it at first seems. Is any CBO analysis that doesn't include the doctors' fix is really worth paying much attention to? It's an analysis of a fantasy world.
Tip for Timid Pundits: The prediction that Democratic health care bill will not reduce the deficit over the long run is about as safe a year-end prediction as you could make. Even with all the budget gimmickry, it wouldn't help cut the budget much--Jon Cohn has the unconvincing graphs to prove it! ... P.S.: I'm not saying that the reform (which I favor for non-deficit reasons) won't help set the stage for at least some cost-restraint in the future. As Hendrik Hertzberg and E.J. Dionne argue, it should be easier to take future action to control medical costs after everyone's covered--then we'll all be in the soup together, and it will be harder for distinct demographic groups (e.g. seniors on Medicare) to argue that they are being singled out for sacrifice unfairly or unnecessarily. But the administration's claim is that the bill as written will by itself cut costs so much that it will reduce the deficit--something that seems plausible only in the artificial alternate universe of the CBO. ... 9:36 P.M.
No recourse for libel posted online? Ben Sheffner argues that Congress would never have passed Section 230 of the Communications Decency Act if it knew what it was doing. ... 10:00 P.M.