Can Congress control costs?
One of the more sophisticated arguments against health-care reform is that for all the sharp policies and elegant initiatives contained in the bill, none of it will work because Congress will vote to roll back the cost savings. The evidence comes from Medicare's Sustainable Growth Rate formula, which Congress passed in 1997 but has refused to implement.
As Jon Cohn explains, however, SGR is the exception, not the rule. Congress has passed plenty of proposals that cut costs in Medicaid and Medicare, and stuck to most of them. SGR really is an exception: It was a formula passed when GDP growth was unusually high and health-care cost growth was unusually low. When GDP growth slumped and health-care costs shot back up, following the payment rates set out by the SGR came to look draconian. The problem is that rather than fix the bill, Congress just passed temporary delays. Repeal would have been more honest.
But more broadly, this argument is a form of political nihilism. In the coming decades, one of two things will happen: Congress will cut health-care costs, particularly in Medicare, or the country will go bankrupt. Saying Congress can't cut health-care costs is not an argument against this bill so much as it is a prediction of eventual economic collapse. That might be an accurate prediction, but it militates in favor of trying to rationalize the system before the moment of total crisis, not opposing attempts to do so.
Graph credit: Congressional Budget Office
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