Why Am I Not Surprised, Again?
UPDATE (3:05 p.m.): The authenticity of the memo referred to below is being challenged. Do we have "Fake but Accurate" II?
John Hinderaker at Powerline produces confirmation of my biggest concern about the so-called financing of the health care reform legislation -- banking on cost-saving in Medicare that I believe will be undone after this bill passes. John has posted a copy of a memo distributed to Democratic staffers. Here's the key excerpt:
One of the many dishonest features of the Democrats' effort to conceal the fact that their plan is a budget-buster is the assumption that reimbursements to physicians under Medicare will decline. This accounts for a large chunk of the Democrats' "savings." In fact, all knowledgeable observers understand that this alleged savings will be illusory because Congress will, in separate legislation, raise those reimbursement levels as in the past. The Democrats' memo acknowledges the party's dishonesty on this point, and urges its staffers to continue misleading the public:
Second, most health staff are already aware that our health proposal does not contain a "doc fix." Some Republicans have repeated CBO's November 18 letter that says "the sustainable growth rate (SGR) mechanism governing Medicare's payments to physicians has frequently been modified ... to avoid reduction in those payments, and legislation to do so again is currently under consideration in the Congress." The inclusion of a full SGR repeal would undermine reform's budget neutrality. So, again, do not allow yourself (or your boss) to get into a discussion of the details of CBO scores and textual narrative. ...
As most health staff knows, Leadership and the White House are working with the AMA to rally physicians support for a full SGR repeal later this spring. However, both health and communications staff should understand we do not want that policy discussion discussed at this time, lest it complicate the last critical push to health care reform.
It couldn't be clearer: the Democrats' strategy is to mislead the American people about the nature, contents and fiscal consequences of their health care takeover.
That second paragraph in the memo, which I have highlighted, is what confirms my suspicions. That the discussions are already underway is disgraceful -- on a par with the shenanigans surrounding the projected costs of Medicare Part D in 2003.
About a month ago, I had a conversation with a colleague working in the Executive Branch. He asked me how I could be for "fiscal responsibility" and yet not for the health care reform, since it lowers projected deficits over the next decade. I told him I will believe it when I see it, and in fact, to allay my suspicions, that the legislated expenditure increases on higher coverage ought to be conditioned on realizing those savings from Medicare. I hate to be this right.
huh? That memo is referring
huh? That memo is referring to the already existing SGR issue, the one Paul Ryan likes to bring up as somehow a deceptive run around by democrats.
If Health care reform passes, they will then go in and fix the SGR.
If health care reform doesn't pass, well, then, they'll go in and fix the SGR.
I understand your point, that projected savings in this bill can later be undone by congressional action. But the memo you've posted has NOTHING to do with this. They don't want to talk about this now because it has nothing to do with the current bill and is only brought up to confuse people and make them think a bipartisan issue like fixing the SGR somehow = duplicity by democrats.
but wait a minute
anyone who's been paying attention has known that Dems were planning to extend the doc fix. It's been in their budgets, and they made a special exemption for it in their paygo law. they tried and failed to do it at the end of last year.
what's more, everyone also knows that the doc fix was going to be passed, whichever party was in power. the only question was whether they would do it one year at a time or all in one swoop.
i don't see how that makes health reform disingenuous, or changes its effect on the deficit. yes, adding the doc fix in the health bill would make the health bill score as a deficit-raiser. but the doc fix exists independently of health reform and would pass whether health reform passed or not. so why should it be treated as integral to health reform?
On the doc fix
You hear a lot about the "doc fix" these days and honestly it's tough for me to determine who is speaking truthfully and who is being disingenuous. This is probably because my grasp on the subject matter is, well, somewhat limited. But to me it seems like this:
The HCR bill imposes a set of costs (S) on the Federal government and then offsets those via new taxes (T) and cost saving (CS) initiatives. So, speaking broadly, the effect on the deficit is S - T - CS. According to the CBO, T + CS > S. Right?
Then we have the doc fix question. This adds another set of costs. Presumably T + CS < S + DF, that's why Democrats don't want it in this bill.
But if DF is a given anyway, which seems likely given that it's supported by pretty much everyone, why should it be included? In other words, if DF is going to be added to the budget whether nor not HCR passes, why is it intellectually dishonest to leave it out of the calculation?
The only way I see it having any bearing is if the CBO uses assumptions based on no-DF to calculate T and CS, i.e. those numbers are variable depending on whether or not DF goes into place. Is that the case? I'm asking sincerely, because I really don't know.
"John Hinderaker at
"John Hinderaker at Powerline"
Got *one thing* right in his whole career there; the rest of the time he's not trustworthy.