Posted by: Jeff | November 18, 2009

Good News On Health Care, Reconsidered

Ezra Klein offers some cautionary notes.

The Senate bill, we now know, costs a smidge under $850 billion during its first 10 years, cuts the deficit by $127 billion, and covers 31 million people. In the second decade, it cuts the deficit by an improbably large $650 billion. But we don’t know anything else. We haven’t seen the CBO’s full score yet, nor do we know any of the specifics in the bill. Reid’s office released the numbers before it let anyone see the language. It wants the numbers burned into the media’s mind. They’re the message, at least for now.

In a way, it’s fitting. Health-care reform is increasingly hostage to numbers that are disconnected from the reality of the bill and its purpose. It’s a real victory to push your bill below $850 billion if the point is to get it below $900 billion. But what if that’s not the point? Most experts think the bill needs about $1.2 trillion to be truly affordable. Compromising beneath $900 billion might be necessary, but it’s nothing to celebrate. It’s a concession, not an accomplishment.

It is, in fact, quite far from the questions that will determine the bill’s success. In 10 years, no one will remember whether the bill cost more or less than $850 billion, and I doubt that the public option, if it remains in the legislation, will be particularly relevant either. They’ll remember whether the bill worked — whether it covered people at a price they could afford, and began the overdue and urgent work of cost control. And we pretty much know the policies that will figure into the analysis.

For the specifics on those policies, you should go read the full post.

The $900 billion ceiling is pretty arbitrary, and seems to have grown out of a random line in Obama’s health care speech to the joint session of Congress. The administration might have had solid political reasons for throwing out that sum, or it might have been a genuine misstep.

At any rate, my impression (gleaned mainly from Klein’s posts) is that the Senate bill just barely clears the bare minimum amount of money needed for health care reform to work properly. And since this is one of those situations where good governance lines up with good politics, everyone who cares about reform really needs this bill to work. We’re cutting things damn close, in the name of what is essentially political cosmetics.

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