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Some worrying signs out of the Senate

PH2009110404502.jpgHealth reform ain't easy.

Expectations were that the Senate would get the CBO score for its health-care bill today. It didn't. Or, to be more precise, it didn't get the CBO score it wanted. The proposal Reid's office sent to the CBO did not come in beneath the $900 billion limit, so the bill is being tweaked and trimmed until CBO gives Reid the answer he's looking for. There's nothing particularly strange about this process, but it means that the proposal that Reid's office thought struck a decent balance between cost and generosity will now become a bit less affordable for individuals in order to cost the government a bit less money.

Similarly, news that Reid is considering a small increase in the payroll tax paid by the rich isn't surprising, but it is, again, a deviation from plan. His office was initially quite clear that it didn't want to add in new revenue measures that hadn't been passed through the committees. The problem it's run into is that there's too much opposition to the excise tax in its current form, but weakening it means you lose revenue, which means your bill isn't deficit neutral. So it's bringing in some new tax revenue, but that comes at the cost of old revenue, and cost-cutting potential.

Photo credit: AP Photo/Harry Hamburg.

By Ezra Klein  |  November 13, 2009; 1:35 PM ET
Categories:  Health Reform  
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Put in a real public option to save money.

Posted by: eRobin1 | November 13, 2009 1:49 PM | Report abuse

Hmm. I think I'd prefer any wriggling come in the form of a more HELP-like employer mandate than a payroll tax. I think it's better both politically and a fairer way to enforce accountability to corporations that are already letting the taxpayers provide benefits to their employees.

Posted by: ThomasEN | November 13, 2009 1:53 PM | Report abuse

Well, as Goldman Sachs says, what's best for the insurance industry is *no reform*, followed by a *watered down* Senate Finance bill, followed by, well, the Senate Finance bill.

So, the choice for such pro-insurance interests as Senate conservative Democrats is between 'no reform' and 'watered down Senate Finance bill', and I think the lattermost is the most likely.

Posted by: En_Buenora | November 13, 2009 2:06 PM | Report abuse

I've been pro-reform all along the way, as the actual bills have been revealed, but I've been emphasizing on my blog for months *how* to bend the health inflation curve downward.

Well, it may be the tentative pilot programs to reduce inflation are not convincing enough to the center, as a means to get serious inflation reduction, to offset the perception of the overall costs of the legislation over time.

What could Reid do?

He could change the language about the pilot programs so that they become a clearly inevitable transistion to cost inflation reduction, instead of only a possibile road.

You'd do that by specifying that the pilots are meant to result in permanent, evolving programs to pay for value (quality/cost), that *will* be expanded in a specified time period. That *will* result in expanding pay-for-value.

Definite, not maybe.

You go from a tentative testing to a...we-are-going-to-do-it language.

Posted by: HalHorvath | November 13, 2009 3:27 PM | Report abuse

Rats are spinning the wheel....

What is new here?

We are also now getting used to Ezra still blessing these deeply flawed bills.

The bill worth among all these was Sen. Baucus. I hated him, but he produced the bill which any sensible person can understand and even if not perfect, would say as a good starting point.

Reid's one - all gimmicks. It is like this - depending upon how house prices are Las Vegas, the fate of America's HCR bills is determined. If prices there are improving, local economy is improving, Nevada residents feel better; chances of Reid getting elected back are not that bleak; we can get a reasonable bill. Anytime all that goes South, Reid runs to make the bill further screwed up.

Rats spinning the wheel....

Posted by: umesh409 | November 13, 2009 3:41 PM | Report abuse

"the proposal that Reid's office thought struck a decent balance between cost and generosity will now become a bit less affordable for individuals in order to cost the government a bit less money."

Cost the government less money? Don't you mean the taxpayers?

Posted by: staticvars | November 13, 2009 10:37 PM | Report abuse

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