Senate Majority Leader Harry Reid has finally released the text of his version of the Democrats’ health care bill. The roughly 2,000 page bill is a monstrosity, pure and simple.
It is fiscal madness, for one thing. CBO’s 10-year projection scores its cost at $848 billion, since CBO is required to use a 10-year window that starts at enactment and the bill is designed to start collecting taxes well before it starts spending money. If you look at the first 10 years of actual implementation, when both the spending and the taxes are in effect, the 10-year cost is $2.5 trillion. The Democrats are proudly pointing to the fact that even with its high cost the CBO says the bill will not increase the deficit in the first ten years, but what that actually means is that in the midst of an economic downturn it raises taxes (and also cuts Medicare for the elderly) enough to cover the gargantuan cost. In fact it raises taxes by almost half a trillion dollars over ten years (including taxes on employers, on the uninsured themselves, and on drugs and medical devices and more), and cuts Medicare by nearly as much. And of course, the deficit neutrality calculation assumes things that will never happen (which, as usual, the CBO does its best to signal to readers of its analysis of the bill, even if it cannot say it outright.) It is based, for instance, on the bill’s claim that some key Medicare physician payments would be cut by 23% in 2011 and would not be restored—which will happen well after hell freezes over.
As the CBO carefully puts it: “The legislation would put into effect a number of procedures that might be difficult to maintain over a long period of time,” and “the long-term budgetary impact could be quite different if key provisions of the bill were ultimately changed or not fully implemented.” This is Washington-speak for “someone is holding a gun to my head.”
Meanwhile, the bill would do basically nothing to address the actual problem at the heart of our health care woes: rising costs. It would bend the government’s health care cost curve up, not down, and it contains all the ingredients that the other Democratic bills have contained for an increase in the cost of private health insurance premiums.
It also does not include the abortion language that was in the House bill to prevent public funding of abortion coverage, which will (or at least should) be a problem for Senator Ben Nelson and perhaps a few other Democrats (let alone for any eventual conference committee). And it does include a public option (which will be a problem for Senator Lieberman and a few others). And of course it consists of a fundamentally unwise approach to financing health care coverage.
So, to sum up: the idea is to spend trillions even as our debt is mounting, inflict massive tax increases on a troubled economy, impose costly mandates on employers as unemployment hovers above 10%, squeeze money out of Medicare not to fix the program’s finances but to create a whole new enormous federal entitlement alongside it, insert the government in countless new ways between doctors and patients, and cause millions of middle-class families to lose the employer-based insurance they have today, pay even higher premiums, and find themselves herded toward a government insurance provider. Oh, and at the end of it all, if we use the methods of counting the uninsured favored by the Democrats, there are still 24 million people without health insurance.
Another sure winner.
Thursday, November 19, 2009
Senate Health Care Bill - The Troubling Details
From the Corner (Yuval Levin):