As featured on p. 218 of "Bloggers on the Bus," under the name "a MyDD blogger."

Monday, May 18, 2009

The Watering Days

The CBO scores every bill in Congress and determines how much money they will cost. Given the already-large budget deficits and the discomfort of Blue Dogs to further deficit spend, that number as it relates to health care was always going to determine whether or not reform would be possible. Jon Cohn reports that the CBO's scoring is coming in lower than expected:

So what does CBO think this time around? Late last month, after weeks of working overtime to keep up with the huge domestic agenda, CBO began delivering some prelimiary estimates on health reform. According to several sources familiar with the estimates, it's something of a good news/bad news story:

The good news for reformers is the CBO's determination that expanding health-insurance coverage would cost a lot less than many outside experts had predicted. Instead of a politically daunting $1.5 trillion, the CBO figures the price tag will be closer to $1 trillion, at least under certain parameters. But the reason for the lower estimate is a bit unsettling. Even with a requirement that everybody obtain insurance--a so-called individual mandate--the CBO assumes a that between a quarter and a third of the uninsured still wouldn't have coverage. That would leave the country short of universal coverage, the goal Obama and his allies have repeatedly cited.

The full story is here. Once again we see how a failure to deal with the nettlesome immigration question impacts policy. No Congress will allow any health care reform to include undocumented immigrants. Yet without doing so, the hidden costs of uninsured emergency room visits will not drop as much as expected. Six or seven million uninsured will fight against cost control. Lack of treatment among the undocumented will lead to high catastrophic care costs. And xenophobes will have even MORE of a reason to demonize "illegals" for stealing health care from Americans, somehow. Practically every domestic policy runs up against this.

This is a symptom of timidity, as is the entire health care reform policy, in many ways:

Of course, lawmakers wouldn't need such favorable scoring if their proposals were a little bolder. If Obama and Congress could get more aggressive about steering reimbursements away from doctors and hospitals that provide poor care, the CBO would undoubtedly credit those moves as generating additional savings. And, if reformers were willing to find more tax revenue--by, say, declaring that premiums for the most generous health plans were no longer fully exempt from personal income taxes--they could raise the money they need. But those are tough political tasks. Providers of medical care don't like their incomes going down; taxpayers don't like their liabilities going up. In the end, Obama and Congress will have to live within certain constraints that the CBO sets--adjusting their proposals to coincide with the agency's predisposition or scaling back what they hope to do. The result might be an imperfect law, but, as the Clinton-care veterans will tell you, sometimes that's better than no law at all.

Or will it be? Robert Reich doesn't think so. The public plan could get subject to so much watering down that it would effectively be a regulated non-profit without anything close to the bargaining power needed to help push down costs.

The endless watering days, where legislation withers and softens, are upon us. And progressives will generally be told to give up and support something instead of nothing. Watch for it.

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