Ezra Klein notices something I’ve seen myself in arguing about the health care bill with conservatives. People understand taxes and spending in the crude sense, and they understand that $900 billion over ten years is a really big number. (Though actually not all that big in the context of the government’s total expenditures, or America’s total health care expenditures, over that same period.) So they have a hard time buying the idea that this bill will potentially cut lots of money from the deficit.
There are basically two ways to save money when it comes to health care. One is to try to cut costs out of government programs, or even get really draconian and slap hard spending limits on those programs. Neither approach is terribly popular, because they involve cutting benefits to individuals or reimbursements to popular interest groups like doctors. So the Democrats pretty much stayed away from those methods in this bill. (Some day, of course, those methods may still be necessary.)
But the other way you can save money is by changing the way government programs spend. This method doesn’t involve any dramatic one-time cuts, but instead makes minor changes to rates of growth in costs that should add up to big savings over time. These changes are usually highly abstract and technical, and involve complicated economic stuff about incentives and payment methodologies and fee-for-service and what-have-you. Their effect is also cumulative over time, so at any one moment it’s hard to see how they’re doing any good. Long story short, people have a hard time understanding this second way of saving money, so they don’t really believe that it works.
But just because you don’t believe in something doesn’t mean it isn’t there. So if you’re so inclined, here’s Klein laying out the five most important cost control measures contained in the health care bill.