Saturday, July 18, 2009

CBO Chief Trashes Reform Bills' Cost Control Efforts

From GoozNews here.

Is this bad news for health care reformers, or a good thing?

Congressional Budget Office chief Doug Elmendorf told the Senate Budget Committee today that the cost savings in the various bills under CBO review will not affect the overall trajectory of health care costs. "On the contrary, the legislation significantly expands the federal responsibility for health-care costs," Elmendorf said, according to the Washington Post.

This testimony, viewed as disastrous by universal insurance advocates, suggests CBO perceives most of the savings put in the House and Senate versions of the legislation as "one-time" events. For instance, eliminating extra payments for Medicare Advantage will raise an estimated $150 billion over the next ten years by eliminating those extra payments, but it does nothing to reduce underlying health care inflation.

And, as I noted in this space at the time, the "savings" promised by the drug and hospital industries in those ballyhooed Rose Garden ceremonies a few weeks ago are voluntary and cannot be scored (nor should they be) by the green eyeshade crowd at CBO.

The Post quotes Arkansas Blue Dog Democrat Mike Ross saying the testimony will galvanize conservatives to push for more cost cutting in the bill. That, to me, is a good thing, as long as it doesn't sink the overall legislation when the provider special interests go ballistic.

As I've also said in this space before, we have to get past the insurance question (get everyone insured so we're all in the same boat) before we can have a meaningful society-wide discussion about getting health care cost growth down to the same rate as the rest of the economy. That, in my view, will require having a national discussion about rationing (which is addressed in this major article by Princeton University bioethicist Peter Singer in the Sunday New York Times magazine).

I also read the New York Times magazine article the other day. Unnecessary (and often harmful) tests, for example, have to be curtailed. My friend in FTL/STL (the one with the schizophrenic boyfriend), for example, told me he had to undergo over 30 tests for a prostate condition when his prostate is basically normal. This kind of over-testing pushes up the price of health care, while potentially harming the patient. The people who own the laboratories, often doctors, are basically profiteering off our healthcare system (including Medicare and Medicaid--not just the health insurance companies). We need some oversight of this now seemingly limitless (and to the patient potentially harmful) spending.

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