Shooting The Messenger Won't Help Reform Health Care

Sen. Max Baucus, one of the leaders of healthcare reform efforts, has depicted the Congressional Budget Office (CBO) as an obstacle to reform because it has so far been unable to score many of the proposals that he has made. And he is urging the CBO to find cost savings wherever it can. “Otherwise, healthcare reform is in jeopardy,” Baucus is quoted as saying.

This is not the first time that Baucus has criticized the CBO’s work in this area. Following the release of a comprehensive CBO report on reform options, Baucus said in February that, if healthcare reform is to pass, the CBO needs to “get ever more creative to find … pathways to get the savings that we have to have.”

Robert Laszewski, whose Health Policy and Marketplace Review blog wields considerable influence, nailed Baucus for his most recent statement. Noting that virtually everyone involved in the reform discussions insists that reform has to save the government at least as much as it costs, Laszewski questions how that can be done unless the CBO’s experts remain unbiased.

“If the CBO just rolls over and lets Congress make up excuses just to spend more for health care we will not have reform–we will only have a bigger fiscal disaster on our hands. How do you reform entitlements by pretending?”

An earlier post by Laszewski summarizes some of the 150 proposals that CBO scored for their potential to reduce federal healthcare spending over the next decade. The proposals covered the waterfront, from insurance and tort reforms to expansion of public programs, changes in the tax system, and changes in how providers are paid and how health care is delivered. It’s worthwhile to quote a few of these just to show how far currently popular proposals are from what’s needed to cover everybody at a cost we can afford.

•    Expand the Hospital Quality Incentive Demonstration to All Hospitals – Saves $2.9 billion by 2019.
•    Pay for a Medical “Home” for Chronically Ill Beneficiaries in Fee-for-Service Medicare – An increase in mandatory spending of $5.6 billion by 2019.
•    Fund Research Comparing the Effectiveness of Treatment Options – The net effect on the deficit between 2010 and 2019 would be an increase of $860 million and “reduce total spending on health care in the United States by an estimated $8 billion over the 2010–2019 period (or by less than one-tenth of 1 percent).”
•    Create Incentives in Medicare for the Adoption of Health Information Technology Including Bonuses and Penalties for all Physicians – A reduction in the deficit of $4.4 billion by 2019.
•    Reduce Medicare’s Payment Rates Across the Board in High-Spending Areas – A savings of $51 billion by 2019.
•    Set the Benchmark for Private Plans in Medicare Equal to Local Per Capita Fee-for-Service Spending – Reduces spending by $157 billion by 2019.

Clearly, what’s needed is a rethinking of our approach to health-care reform. But slamming the CBO for insufficiently “creative” thinking is not going to do it.