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Democrats get the bill, and the score, they needed

PH2010031704193.jpg

The question people generally ask about the final health-care reform vote is, "Won't it be politically difficult for many House Democrats to vote yes?" But with the release of the CBO report (pdf), I'd flip that question a bit: Won't it be substantively difficult for many House Democrats to vote no?

If you're a liberal House Democrat, here's what you'd be voting against: Legislation that covers 32 million people. A world in which 95 percent of all non-elderly, legal residents have health-care coverage. An end to insurers rescinding coverage for the sick, or discriminating based on preexisting conditions, or spending 30 cents of each premium dollar on things that aren't medical care. Exchanges where insurers who want to jack up premiums will have to publicly explain their reason, where regulators will be able to toss them out based on bad behavior, and where consumers will be able to publicly rate them. Hundreds of billions of dollars in subsidies to help lower-income Americans afford health-care insurance. The final closure of the Medicare Prescription Drug Benefit's "doughnut hole."

If you're a conservative House Democrat, then probably you support many of those policies, too. But you also get the single most ambitious effort the government has ever made to control costs in the health-care sector. According to the Congressional Budget Office, the bill cuts deficits by $130 billion in the first 10 years, and up to $1.2 trillion in the second 10 years. The excise tax is now indexed to inflation, rather than inflation plus one percentage point, and the subsidies grow more slowly over time. So one of the strongest cost controls just got stronger, and the automatic spending growth slowed. And then there are all the other cost controls in the bill: The Medicare Commission, which makes entitlement reform much more possible. The programs to begin paying doctors and hospitals for care rather than volume. The competitive insurance market.

This was a hard bill to write. Pairing the largest coverage increase since the Great Society with the most aggressive cost-control effort isn't easy. And since the cost controls are complicated, while the coverage increase is straightforward, many people don't believe that the Democrats have done it. But to a degree unmatched in recent legislative history, they have.

The Medicare Prescription Drug Benefit didn't try to offset its costs. It just increased the deficit. And Medicare and Medicaid were passed in the days before the Congressional Budget Office even existed. For health-care reform, Democrats have gotten the toughest scorekeeper in Washington to bless their effort, and though many don't think that's good enough, it's a lot more than anyone else has ever done.

People pay a lot of attention to the difficult politics of health-care reform, but at the end of the day, the task of writing the policy will be seen as the harder, and more consequential, element of this effort. But it worked. Democrats got the score they needed, and now they can go to their liberals and say that this is closer to universality than we've ever been, and they can go to their conservatives and say this does more for deficit reduction than has ever been done, and both things will be true.

If this bill does pass on Sunday, that, and not deals or polls or rides on Air Force One, will be why.

Photo credit: By Melina Mara/The Washington Post

By Ezra Klein  |  March 18, 2010; 12:30 PM ET
Categories:  Health Reform  
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Comments

Ezra,

you're absolutely right in your stance towards liberal and conservative dems IF those figures hold?

Onto Medicare Part D? If that's such a boondoggle and so fiscally unsound why not just repeal it?

Remind me again if Medicare is "paid for" too?

Posted by: visionbrkr | March 18, 2010 12:35 PM | Report abuse

Exactly, visionbrkr, it's all just a guess (and if Ezra was being honest, he would admit it will end up costing more). The double counting of the Medicare "assets" and the doctor fix alone make the CBO score a sham. Moreover, the $500 billion in increased taxes "pay" for health insurance by making it more expensive, GREAT solution there!

Posted by: JakeD2 | March 18, 2010 12:39 PM | Report abuse

But Faux News will say mean things about me if I vote yes! And the screaming Teabaggers! Oh, it would be so much easier to vote no, because then, surely, Faux and the Teabaggers will be kind, right?

"Exchanges where insurers who want to jack up premiums will have to publicly explain their reason, where regulators will be able to toss them out based on bad behavior, and where consumers will be able to publicly rate them."

Yeah, but will that really happen? I'm not holding my breath.

Posted by: AZProgressive | March 18, 2010 12:40 PM | Report abuse

The 95% claim does not add up, even after subtracting for so-called "illegals" and excluding them:

Twenty-one percent of the uninsured are immigrants, according to the Kaiser Family Foundation. But that figure includes both those who are here legally and those who are not. The number of illegal immigrants who are included in the official statistics is unknown. Best estimate is about 58% of the 21% are “illegal.” That means subtracting the “illegals” still leaves is means 12.2%. So if 47 million are uninsured (and by the way, the real number is probably over 50 million thanks to the recession), then that is 41.2 million. Which means 30 million is still 73% not 95%.

See:
http://www.factcheck.org/2009/09/thirty-million-uninsured/

http://www.factcheck.org/2009/03/uninsured-us-citizens/

And that assumes the rest of their assumptions are correct and honest. heh.

We will need single payer eventually.

Posted by: drsteveb1 | March 18, 2010 12:41 PM | Report abuse

drsteveb1:

You just figured out that the Dems are lying?

Posted by: JakeD2 | March 18, 2010 12:43 PM | Report abuse

So, what do you think the odds are that it will pass? I think they are pretty good. I think this is going to become law, and though I'm extremely skeptical that it will solve more problems than it creates, I don't think it will be the end of America as we know it. Thus, the critics will start looking foolish fairly quickly, and objections that "this doesn't take effect until 2014, and you won't see the full impact of this until then" are going to ring hollow.

Politically, it makes no sense for any Democrat to vote against this, or for any Republican to vote for it. So, since the Democrats have the majority, this really should pass.

@vision: Medicare Part D is a boondoggle and fiscally unsound, but when the Democrats point that out, they don't want to repeal it. They might want to amend it so it pays for drugs imported from Canada, but most of the left's complaints about the cost of Medicare Part D is that there were no corresponding increases in taxes. They want to raise taxes. Thus the complaint. If they raise or add taxes to "pay" for Medicare Part D, then they will consider all the problems with Medicare Part D "fixed". Because tax increases are the answer to everything!

Posted by: Kevin_Willis | March 18, 2010 12:44 PM | Report abuse

"If you're a liberal House Democrat, here's what you'd be voting against..." Ezra, what you actually mean is if you're any kind of a Democrat at all. Get this business done for the good of the country and let's please -- please -- move on.

Posted by: CopyKinetics | March 18, 2010 12:44 PM | Report abuse

a beautiful, heartening and eloquent post.

we have every reason to be hopeful today....
and if and when this bill passes,
it will really be a great and wonderful victory.
it will be a day
when we can all feel proud,
that the united states is finally back on track.
what a really wicked battle that has been....
but there will soon be light
at the end of this tunnel!

i am so hopeful today.
may all of this come to pass.
what a victory it will be for this administration,
for all of those who have supported and stood by
president obama,
and those who fought so hard for health care reform.
those, like wyden and rockefeller....
realists, leaders with good hearts.....
the day this is signed into law,
we will have many people to thank,
including you, ezra klein!

Posted by: jkaren | March 18, 2010 12:45 PM | Report abuse

@AZProgressive: Are you saying that oversight of insurance exchanges will be done with the effectiveness and efficiency of the SEC keeping an eye on the Wallstreet fatcats? Like their refusal to seriously investigate Bernie Madoff after repeated warnings and whistleblowing?

I can't imagine insurance companies would be able to corrupt the process by which the insurance exchanges get overseen. They only have tons of money and influence, and those who oversee the exchanges will probably be friends of or come from the insurance industry. Because, you know, they're already experts.

Posted by: Kevin_Willis | March 18, 2010 12:48 PM | Report abuse

KevinWillis,

well then WHY did Rep Eshoo increase the time frame of biologics from brand to generic from 7 to 12 years? Maybe its because she's in PRIME biologics country?

And why doesn't Ezra bring this FACT up?

hmmm.

Posted by: visionbrkr | March 18, 2010 12:50 PM | Report abuse

The reasons it doesn't make political sense for Republicans to vote for it are: 1) it helps people, and 2) it reduces the deficit as compared to the status quo. Republicans like ADDING things to the deficit that DON'T help many people, like tax cuts for the wealthy. They don't go out and say this into the mikes, they go out and say "socialism / fascism / government takeover ", etc. My question is, what is wrong with the 27 percenters that they haven't figured out to watch what they do and not what they say? Do they need a puppet show?

Posted by: Jenn2 | March 18, 2010 12:52 PM | Report abuse

jkaren:

Nice thoughts (assuming that Obama is legally President of course : )

Posted by: JakeD2 | March 18, 2010 12:53 PM | Report abuse

AZProgressive,

insurers are already rated.

look here:

http://www.ncqa.org/tabid/60/Default.aspx


and consumers have NO CLUE as to how to "rate" an insurer. that's like webmd having patients rate doctors. Again no clue.

Posted by: visionbrkr | March 18, 2010 12:54 PM | Report abuse

Vision and Kevin - The problem with Medicare part D, other than it not being payed for, is that it specifically prohibits America from collectively bargaining on drug prices. This is why the rest of the industrialized world pays far less for drugs than we do; they bargain for their drugs and we don't. The whole re-importation from Canada thing is silly.

We are, in effect, subsidizing the rest of the world's drugs. Do pharaceutical companies need to make a profit? Of course they do. Does that profit need to be made in America only? Not if they are selling their drugs globally, no.

And Kevin, it is not that Democrats just want to raise taxes, it is that they don't want to just load up the national debt. Democrats want fiscal sanity, while Republicans, as Dick Cheney said, don't think deficits matter.

Posted by: nisleib | March 18, 2010 12:54 PM | Report abuse

Jenn2:

There are plenty of things that would "help people and reduce the deficit" that even YOU would be against, so don't give me your song and dance (or even puppet show ; )

Posted by: JakeD2 | March 18, 2010 12:55 PM | Report abuse

plenty of things that would "help people and reduce the deficit"

Okay, I'll bite.

Posted by: Jenn2 | March 18, 2010 12:59 PM | Report abuse

We could "help" inmates and cut prison spending 100% just by closing all jails.

Posted by: JakeD2 | March 18, 2010 1:00 PM | Report abuse

"If this bill does pass on Sunday, that, and not deals or polls or rides on Air Force One, will be why."

you haven't worked in Washington very long, have you?

Posted by: NoVAHockey | March 18, 2010 1:00 PM | Report abuse

Jake, I think you should send that policy recommendation to McConnell posthaste.

Posted by: Jenn2 | March 18, 2010 1:01 PM | Report abuse

I've said this before and will say it again: REPUBLICANS CAN'T EVEN DELIVER A PIZZA IF THEY TRIED. Their first attempt to kill this bill was by throwing up the CBO as a score keeper. They knew that if the CBO figures were against the Democrats, the bill would be DOA. Now that the CBO can't provide them with cover, they're going after "the process". Never mind that they've used the same process more times that Democrats, now they find the process to be so offensive and odious that it's almost unAmerican to ever use "the process". Combined with the Tea Party, Fox News and every conservative tool out there pointed right at killing the bill, the Republicans are flummoxed because the bill keeps moving forward. What the Republicans don't want to ever have to do is explain why they voted against expanding coverage and making insurance company tactics illegal. They want the Democrats to have to explain why they couldn't get the bill passed. The way it seems though, the Republicans will have to confront their fear of explaining why they're for insurance companies bad behaviors rather than for the American people. Their best hope is that the bill dies somehow so that they won't ever have to face the heat on this.

Posted by: ATLGuy | March 18, 2010 1:05 PM | Report abuse

drsteveb,

Your calcs are mistaken. The 95% claim is not that the bill will reduce the number of uninsured by 95%. It is that the insured portion of the total nonelderly, legal population in 2014 will rise to 95% from its current 83%. Read the CBO report, please.

Posted by: gedwards1 | March 18, 2010 1:06 PM | Report abuse

It certainly isn't perfect, but as Klein points out, it's a far better bill than anything anyone else has ever come up with. It's good for the people, and good for the bottom line.

Now get it passed and let's move on to other pressing matters.

Posted by: js_edit | March 18, 2010 1:12 PM | Report abuse

nisleib,

I agree with you. Its Eshoo (D) that caused the problem with biologics. That fiasco in 10 years will make Medicare Part D look like its reducing the deficit.

The idea of drug reimportation is silly becuase if they're made here the best deal SHOULD be here.

I likewise have no problems with pharma profiting. Do they need to profit at 20% year over year? hmmm.

Posted by: visionbrkr | March 18, 2010 1:12 PM | Report abuse

Just a couple things to keep in mind as Democrats (and Ezra Klein) rejoice with glee over the CBO report today:

1) the 'non-partisan' CBO is run by a former Clinton staffer and unabashed 'progressive' Democrat. I'm sure that doesn't contribute at all to the favorable calculations. I'm just say'n.

2) the CBO is notoriously WAY off when it comes to estimating expenses of legislation. Think of the new Capital Hill visitors center. The CBO estimated it would cost $70 million. It ended up costing over $600 million.

It's not that I expect any less celebrating from Democrats. This CBO report is exactly what they were hoping for. What I would expect is that there would be at least one serious journalist at the WaPost who could put their leftist "perspective" to the side long enough to ask this question: what happens when the $940 billion inevitably becomes $2 trillion? Or $5 trillion? What happens to the deficit then?

If Democrats had any courage at all, they would insist that their list of changes to the Senate bill contain a provision that guarantees the American taxpayer that their health care reform will be deficit neutral. That means when the cost overruns come - and they will -, benefits will have to be slashed by law.

It should not be left to the courage of the next generation of politicians to undo the harm liberals are doing today. That sort of cowardice to pass feel-good legislation today and let tomorrow's generation figure out how to pay for it is best left to the likes of FDR and LBJ. Courage to fix the problems created by left-wing legislation is not a quality found often in politicians.

Read: Social Security.
Read: Medicare.

Posted by: dbw1 | March 18, 2010 1:15 PM | Report abuse

Ezra, perhaps you may be able to suggest to your colleagues at the Post to stop referring to the bill as the $875 billion bill. See for example the discussion of a self-executing rule yesterday: "They can be used in all kinds of instances, such as saving time on debating and voting on a minor amendment, avoiding a politically embarrassing floor vote, and ensuring majority support and passage of a bill. They have never been used to pass legislation as momentous as the $875 billion health-care package, however."

Maybe the Post could call it a $130 billion deficit reduction bill.

And perhaps when papers talk about Republican plans to repeal the bill if they take control, there should be some discussion of how they a) plan to pay for the repeal and b) the political implications of repealing popular insurance reforms, ending the doughnut hole, etc. Maybe they will do what they did when they created the drug benefit -- namely, just not pay for it. But most papers never mention that fact either.

Posted by: oldwiseman | March 18, 2010 1:16 PM | Report abuse

@nisleib: "And Kevin, it is not that Democrats just want to raise taxes, it is that they don't want to just load up the national debt."

I hear what you're saying, but I'm still not convinced. ;)

"The problem with Medicare part D, other than it not being payed for, is that it specifically prohibits America from collectively bargaining on drug prices."

Yes, that, too. My apologies for not mentioning the lack of bargaining power written into Medicare Part D so the taxpayer would end up being on the hook for whatever Big Pharma wanted to charge.

Keeping in mind, I never supported a Medicare Part D in the first place.

Posted by: Kevin_Willis | March 18, 2010 1:34 PM | Report abuse

@Jenn2: "The reasons it doesn't make political sense for Republicans to vote for it are: 1) it helps people, and 2) it reduces the deficit as compared to the status quo. "

No, it doesn't make sense for the Republicans to vote for it because (a) most of their constituents, and especially the base, are opposed, and not just to this specific piece of legislation, but to the concept of "socialized medicine" in general. And they need those people to vote for them if they are going to stay in office. And . . .

(b) all other things being equal, preventing a legislative victory for Obama on a signature issue will help them enjoy more electoral victories in November.

Finally, I think that many of them don't actually believe it's going to help people, or help people more than it hurts them. I don't really think it's because they actively want people to suffer and just hate humanity and like death and sickness. Maybe I'm way off base there, I don't know.

As far as reducing the deficit goes, the Republicans have never shown any sign of wanting to reduce the deficit, so I think that's probably a non-issue on that side of the aisle. However, for those where deficit reduction might actually be an issue, I expect that they think the CBO is wrong--and it almost surely is--and that healthcare reform will end up, in the short- and long-term, costing much more than we're being told.

Posted by: Kevin_Willis | March 18, 2010 1:42 PM | Report abuse

The CBO is run by communists and marxists.

Posted by: TomServo | March 18, 2010 1:43 PM | Report abuse

I am increasingly thinking that any Democrat who votes against health care must be politically crazy.

Posted by: opinionpieces | March 18, 2010 1:43 PM | Report abuse

The Congressional Budget Office is nonpartisan, so its report is impartial.
Nothing, no report, no observer who disputes lies of the rabid right will ever satisfy the rabid right.
Raving lunacy in this very space from some of the Limbaugh legion makes this clear. Don't disturb the ravers with facts.
Argument is useless. Reason is useless.

Posted by: jimsteinberg1 | March 18, 2010 1:46 PM | Report abuse

they score they needed? it costs more than either the original house or senate version and everybody knows the deficit reudction prowess of the bill is a lie because they could just reduce the deficit by many times more by simply using all this new revnue on REDUCING THE DEFICIT instead of paying for what amounts to not even universial health care coverage.

klein is a shill, the dems leaders are schlups and obama is a non-factor. he's using the most obscene narcisitic argument now; "save my presidency from myself!!"

Posted by: dummypants | March 18, 2010 1:47 PM | Report abuse

OBAMA PROMISES:

"THIS HEALTHCARE BILL WILL SIGNED BEFORE THE AUGUST(2009) VACATION".

"THIS HEALTHCARE BILL WILL BE SIGNED BEFORE THE END OF SEPTEMBER(2009)".

"THIS HEALTHCARE BILL WILL BE SIGNED BEFORE THANKSGIVING(2009)".

"THIS HEALTHCARE BILL WILL BE SIGNED BEFORE CHRISTMAS(2009)".

"THIS HEALTHCARE BILL WILL BE SIGNED BEFORE JAN 20TH".

"THIS HEALTHCARE BILL WILL BE SIGNED BEFORE THE STATE OF THE UNION ADDRESS".

"THIS HEALTHCARE BILL WILL BE SIGNED ON MARCH 18TH BEFORE MY TRIP TO ASIA".

"THIS HEALTHCARE BILL WILL BE SIGNED SUNDAY MARCH 21ST BEFORE NOON".

"THIS HEALTHCARE BILL BE WILL BE SIGNED...............................".
??????????????????????????????????????
???????????????????????????????????????
??????????????????????????????????????


AND COUNTING!!!!!!!


Posted by: jjcrocket3 | March 18, 2010 1:47 PM | Report abuse

@TomServo: "The CBO is run by communists and marxists."

Well. To each their own opinion (according to their needs), I suppose. But I'm not even saying the CBO is particular partisan. Maybe it is, maybe it's not. Probably not. But it is frequently wrong, and the scoring methodology is frequently gamed.

Posted by: Kevin_Willis | March 18, 2010 1:48 PM | Report abuse

"According to the Congressional Budget Office, the bill cuts deficits by $130 billion in the first 10 years, and up to $1.2 trillion in the second 10 years"

So, Congress delays the actual tough decisions for years, and you believe they'll happen? Would you like to buy a bridge?

"If this bill does pass on Sunday, that, and not deals or polls or rides on Air Force One, will be why."

Do you mean that you believe no deals have been or will be cut? If not, why did you write that sentence? If so, let's get back to that bridge ...

Posted by: ostap666 | March 18, 2010 1:51 PM | Report abuse

@jjcrocket3: I think your caps lock key is stuck. It'd next to the "A" on your keyboard. You should check it out.

That being said, it looks pretty close to being signed, this time. But the list of overly-specific commitments that healthcare would be law, all of which have thus far turned out to be wrong, is a funny one. And should be humbling, though apparently it's not.

Posted by: Kevin_Willis | March 18, 2010 1:51 PM | Report abuse

So, your logic, Kevin, is a)political reason #1 and b) political reason #2. I'm not arguing that they hate humanity and like death and sickness. I'm arguing that they have some excellent taxpayer-funded health care, and their families have some excellent taxpayer-funded healthcare, and they just flat don't care about trying to come up with solutions for people who don't. It's passive rather than active. And then your final point is just that the CBO is probably wrong, hey, maybe it is, but just for once can we take a look at the the Magical Free Market God Wants For Us and acknowledge that it isn't holding down costs so well, whereas countries with much more government involvement are slowing their medical cost increases considerably compared to ours? If you're going to say that a new plan doesn't hold down costs, it helps to have some alternative other than a status quo in which costs are doubling every 9 years. But, you know, applying evidence, reason, logic, and facts to those thoroughly steeped in ideology and concern for their own political future is like trying to groom Sarah Palin for the Mensa presidency. I'm just interested to see that the more evidence comes out against them, the more firmly entrenched they become in their own ideology.

Posted by: Jenn2 | March 18, 2010 1:52 PM | Report abuse

On claims on nonpartisanship, I quote Ralph Waldo Emerson: "The louder he talked of his honor, the faster we counted our spoons."

Posted by: Kevin_Willis | March 18, 2010 1:53 PM | Report abuse

@Jenn2: "It's passive rather than active."

Gotcha. My apologies for missing your original point.

"can we take a look at the the Magical Free Market God Wants For Us and acknowledge that it isn't holding down costs so well, whereas countries with much more government involvement are slowing their medical cost increases considerably compared to ours"

Oh, absolutely, and fair enough. I'm not arguing that the status quo is going to save us money, either, just that projections of deficit reduction while simultaneously expanding coverage to an additional 32 million people simply aren't credible. So I don't think the Republicans are objecting to the bill on the basis that they believe it will reduce the deficit, and they don't like deficit reduction.

"I'm just interested to see that the more evidence comes out against them, the more firmly entrenched they become in their own ideology."

While there is certainly an ideological objection to socialized medicine (which would be single payer or the public option) or more government regulation (which is much of what the current legislation is), the current entrenchment of the Republicans is political, not ideological. They've got legislation(in current HCR) that reflects much of the things they've said they supported over the years, so this isn't an ideological battle. It's a political battle.

Posted by: Kevin_Willis | March 18, 2010 2:00 PM | Report abuse

I love this bit from the CBO report:

"Although CBO does not generally provide cost estimates beyond the 10-year budget projection period, certain Congressional rules require some information about the budgetary impact of legislation in subsequent decades, and many Members have requested CBO’s analyses of the long-term budgetary impact of broad changes in the nation’s health care and health insurance systems. Therefore, CBO has developed a rough outlook for the decade following the 2010-2019 …. Our analysis indicates …. The imprecision of that calculation reflects the even greater degree of uncertainty that attends to it, compared with CBO’s 10-year budget estimates."

"[D]oes not generally" and "rough outlook" and "imprecision," but, good gosh almighty, you're hyperventilating over the 2nd 10 years. You remind me of a car salesman when you get like this.

Posted by: ostap666 | March 18, 2010 2:01 PM | Report abuse

"that projections of deficit reduction while simultaneously expanding coverage to an additional 32 million people simply aren't credible."

But why do people keep pretending like it is impossible to expand something and reduce a deficit if what you're expanding is paid for? I don't have any more idea than you do if whether or not in the year 2023 things are going to look like the CBO says they're going to look, but there shouldn't be any problem with the principle that you can actually expand coverage and reduce the deficit if the mechanisms are there to pay for the additional coverage and to rein in costs. You want to dispute whether it does that, fine, but people keep acting like it's just impossible under any circumstances. It's like saying that it's simply impossible to simultaneously buy a more expensive house and reduce your debt, even if you get a raise and pay off your car.

Posted by: Jenn2 | March 18, 2010 2:07 PM | Report abuse

So did Mr. Obama describe this bill as basically a Republican bill (i.e., what the Repubs had on the table in the 90's with Bob Dole et al.), and, if so, are the Repubs, in some respects, basically getting what they want?! I mean, how underhanded are the Repubs being here, and have they manipulated the Dems into doing their bidding? Wouldn't surprise me.

Posted by: Fletch_F_Fletch | March 18, 2010 2:16 PM | Report abuse

"but there shouldn't be any problem with the principle that you can actually expand coverage and reduce the deficit if the mechanisms are there to pay for the additional coverage and to rein in costs"

Because I don't believe for a second that the mechanisms to control costs will actually be implemented. Are we going to limit access to new technologies or address end-of-life care. This whole thing is based on increased taxes and the implementation of comparative effectivenss. There's only a cople of problems. First is that comparative effectiveness research is just getting off the ground. Second is that nobody -- nobody -- is going to opt for the "cheaper" and "older" technology when the latest and greatest is available. So you have to have a system in place to force/entice them to use the cheaper alternative. And then the phones will ring in Congress and the resctrictions will be lifted.

Posted by: NoVAHockey | March 18, 2010 2:24 PM | Report abuse

The GOP was for CBO scoring before they were against it! LOL

Posted by: risejugger | March 18, 2010 2:29 PM | Report abuse

"The Medicare Prescription Drug Benefit didn't try to offset its costs. It just increased the deficit."

So the proposed Part D "donut hole" closure will remain the only part that IS paid for? True or false?

If true, how wonderful to have a fully paid Obama fix smack dab in the middle of the flawed plan Bush put on the credit card!

Posted by: jgau4 | March 18, 2010 2:33 PM | Report abuse

jenn2:
"It's like saying that it's simply impossible to simultaneously buy a more expensive house and reduce your debt, even if you get a raise and pay off your car."

It looks like there may be hope to reach a liberal. See, jenn2, what they are doing is like if you go ahead and sign the papers to buy a house that's twice as big as the one you have now, and the only way you can pay for it is IF you pay off your car debt and IF you get a 50% raise next year.

Now, your friends look at you like you are nuts. You have $0 in your savings account, $150,000 run up on credit cards, and the last time you got a raise was three years ago - and it was 2%, not 50%. So history does not lend much credibility to your 'deficit reduction' plan of buying a bigger house with nothing but the promise of a future raise and no money in the bank.

And yet you gleefully walk away from the table talking about how much money you just 'saved' by buying the bigger house.

See, liberals, how common sense just doesn't work with leftist spend-now-ask-questions-later policies?

Posted by: dbw1 | March 18, 2010 2:36 PM | Report abuse

Health care reform is crucial to the competitiveness of the US economy and to our future prosperity. The status quo is simply not an option. If your aims include reducing the cost of health care and to covering more people without health care, you ought to push aside the partisan BS coming from both camps, call your representative and ask them to vote for the health care reform bill. The project of reform needs to get underway.

Posted by: maq1 | March 18, 2010 2:41 PM | Report abuse

For Dr Steve and jake and others who are math-challenged, here's how it works. If there are 47 million uninsured right now and this bill will insure 32 million of them, that leaves 15 million uninsured. We are a country of approx. 300 million. Dividing will reveal that 5% of the general population will reamin uninsured and 95% will be insured.

Posted by: NMModerate1 | March 18, 2010 2:41 PM | Report abuse

Are you smoking dope!!! the $138B deficit reduction includes
1. $50B in Medicaid cuts passed to the States (don't think that saved the tax payers any money)
2.$47B-$87B by Eliminating the loan subsities (not sure what that has to do with Healthcare.

...and it still does nothing to address the spiraling costs of healthcare.

Obama should be ashamed of the sham against the American Public. Throwing Student Loans savings to "Buy off" votes.

Posted by: rhino2 | March 18, 2010 2:45 PM | Report abuse

I recommend this:

If this atrocious healthcare "bill" currently before Congress fails, vote for any Democrat in 2010 that voted against it.

If this atrocious healthcare "bill" currently before Congress passes, vote against every Democrat in 2010, regardless of how they voted in regard to this "bill".

Posted by: MKS1 | March 18, 2010 2:46 PM | Report abuse

The false dilemma that so many want you to believe is that your choices are (1) this excuse for a "bill," or (2) nothing.

The truth is: there is a far superior bill, HR 3400, that has been around for some time, does not increase the size and coercive power of government, and truly helps the underserved.

Why do you not hear much about it? It is sponsored by a conservative.

Posted by: MKS1 | March 18, 2010 2:52 PM | Report abuse

Ezra... Another George Stephanopoulos indistinguishable from Robert Gibbs.

If this bill passes, it will prevent the Congress from passing anything meaningful until it is repealed or SCOTUS knocks it down. The voters will vote the Democratic majority out of both houses and Obama will await his turn in the tumbrel in 2012.

This bill will never become functional and that's a good thing for the country.

Posted by: gmonsen | March 18, 2010 3:00 PM | Report abuse

Hardly surprising Klein and other neo-liberals support the Obama/Reid/Pelosi health care bill. Most, if not all of them, would support any bill favored by Obama, being loyal partisan Democrats.

Klein conveniently does not mention most of the limited reforms do not go into effect until 2014. He ranted, justifiably in my opinion, about Lieberman's opposition to the Medicare buy-in for persons between fifty-five and sixty-four, describing how tens of thousands would needlessly die each year by not having health care benefits. This is still true with the Obama/Reid/Pelosi bill, but no complaints from him and other partisan Democratic columnists, who earlier expressed concerns about this.

Posted by: Aprogressiveindependent | March 18, 2010 3:11 PM | Report abuse

@MKS1: "If this atrocious healthcare 'bill' currently before Congress passes, vote against every Democrat in 2010, regardless of how they voted in regard to this 'bill'"

I already do this 95% of the time (vote against the Democrats). Your strategy doesn't really give me any new or interesting options.

Posted by: Kevin_Willis | March 18, 2010 3:19 PM | Report abuse

After this vagrant display of unconstitutionality for the acquisition of power, I will never/ever vote for a Democrat, again- period; end of conversation.

Posted by: nosam32 | March 18, 2010 3:19 PM | Report abuse

Republicans and conservatives and teaparty types reactions today:
blah blah blah CBO BAD blah blah blah CONCERN TROLLING blah blah blah TYRANNY blah blah blah rise and repeat.....

The freak out is a bit entertaining in its desperation.

Posted by: vintagejulie | March 18, 2010 3:27 PM | Report abuse

Ezra:

You forgot to pick up your pom-poms when you got up off your knees to write this drivel.

These "cost savings" are pure smoke and mirrors and you know it.

The CBO did it's job, but they were gamed into scoring a fraud. And even with that, the CBO says these numbers are sketchy at best.

Anyway, you can pick up your pom-poms in the Oval Office any time you like. And you might want a Wet Nap to clean off your face.

Posted by: etpietro | March 18, 2010 3:47 PM | Report abuse

"leftist spend-now-ask-questions-later policies?"

Hell, at least they're asking questions. The Republicans just spend on wars and tax cuts and keep pretending like they're some kind of fiscal conservatives. Like I said, you really should seek out a puppet show to illustrate the need to watch what they DO, not what they SAY. Good grief, read Ezra's stuff about investing. There's spending that pays off, and spending that doesn't pay off. Keeping up a spending system where costs double every 9 years and being uninterested in changing that doesn't pay off in the long term.

Posted by: Jenn2 | March 18, 2010 3:50 PM | Report abuse

Should be an easy vote now.

If you are FOR cutting the deficit by more than a trillion dollars, you are FOR health care reform.

If instead you are FOR adding a trillion dollars to the deficit, you are against health care reform.

Easy as that.

Posted by: ram9478 | March 18, 2010 4:22 PM | Report abuse

I've asked this on several other blogs today and no one seems to want to answer my question. If, as republicans say that "Deem and Pass" is unconstitutional ( and they say they will go to court to prove it)does that make all the bills republicans passed with "D&P" unconstitutional also ?

Posted by: jmfromdc | March 18, 2010 4:39 PM | Report abuse

ROTFLOL!!!!! Who on earth would listen to the ranting of Ezra Klein!?!??? This guy is a well heeled lapdog of the likes of MSNBC's Olberman and Maddow. This guy is a committed left wing nut who doesn't have one shred of objectivity.

Posted by: SayWhat5 | March 18, 2010 4:42 PM | Report abuse

It's not a perfect bill, but it is a good beginning. The U.S. needed to take this first step. The Republicans were determined to obstruct this from the beginning no matter what. They've been completely dishonest brokers in this process. The Party of No will be on the wrong side of history, just like they were with Medicare and Social Security.

Posted by: ggwalt | March 18, 2010 4:53 PM | Report abuse

We all know you can't polish a turd so why do liberals continually refer to themselves as progressives

Posted by: jcory | March 18, 2010 4:54 PM | Report abuse

The proposal doesn't realistically address costs, and will do nothing to reduce them.

Why does anyone imagine that insurance companies will charge LESS for something, if the government REQUIRES us to buy it?

That isn't logical, and so it isn't how it will work. Insurance companies will charge more, not less, claiming they have to, since they can't exclude people anymore based on alleged pre-existing conditions. That is to say, insurance companies will have to sell insurance to people who actually need it... and in exchange, the government will force everyone who DOESN'T need it to buy it anyway.

My guess is that people compelled by the mandate to buy insurance, whether they want to or not, will have a lot more to say about this, come election time, than anyone else.

Congress might be passing something now that will only be undone after the next election (and likely before it has any chance to go into effect).

Posted by: Iconoblaster | March 18, 2010 5:01 PM | Report abuse

jcory-- because we believe that eventually you'll be able to pull yourself out of the toilet

Posted by: jmfromdc | March 18, 2010 5:03 PM | Report abuse

The only thing I want to know is which Congressman (or woman's) vote was bought with "Sec. 1107. Payment for Imaging Services. Sets the assumed utilization rate at 75 percent for the practice expense portion of advanced diagnostic imaging services."

Posted by: JakeD2 | March 18, 2010 5:08 PM | Report abuse

This is not the bill we want.
But it is a bill we need.
Without it the door slams closed.

The struggle for progress is not easy.
That's why its called struggle.

With this bill our foot is in the door.
It can't be closed.

And then we can get the bill we want.
Because with the door open the struggle gets easier.

Posted by: apspa1 | March 18, 2010 5:15 PM | Report abuse

Lets be honest here where we talk about this bill containing costs. We all know this bill at best MIGHT reduce federal deficits. However, it does NOTHING to actually contain rising health care costs. In addition if you add coverage to 30+ million people there is no way it can't cost more. Those costs will have to be carried by someone. Most likely it will take the form of increased premiums and reduced service for those that already have health insurance.

Posted by: BradG | March 18, 2010 5:25 PM | Report abuse

Just a couple things to keep in mind as Democrats (and Ezra Klein) rejoice with glee over the CBO report today:

1) the 'non-partisan' CBO is run by a former Clinton staffer and unabashed 'progressive' Democrat. I'm sure that doesn't contribute at all to the favorable calculations. I'm just say'n.

2) the CBO is notoriously WAY off when it comes to estimating expenses of legislation. Think of the new Capital Hill visitors center. The CBO estimated it would cost $70 million. It ended up costing over $600 million.

It's not that I expect any less celebrating from Democrats. This CBO report is exactly what they were hoping for. What I would expect is that there would be at least one serious journalist at the WaPost who could put their leftist "perspective" to the side long enough to ask this question: what happens when the $940 billion inevitably becomes $2 trillion? Or $5 trillion? What happens to the deficit then?

If Democrats had any courage at all, they would insist that their list of changes to the Senate bill contain a provision that guarantees the American taxpayer that their health care reform will be deficit neutral. That means when the cost overruns come - and they will -, benefits will have to be slashed by law.

It should not be left to the courage of the next generation of politicians to undo the harm liberals are doing today. That sort of cowardice to pass feel-good legislation today and let tomorrow's generation figure out how to pay for it is best left to the likes of FDR and LBJ. Courage to fix the problems created by left-wing legislation is not a quality found often in politicians.

Read: Social Security.
Read: Medicare.


Posted by: dbw1 |
----------
Actually the CBO only considers the legislation in its present format without considering the long term effect or changes that may occur down the road.

There was no CBO (created in 1974) scoring when Social Security was passed because at that time many of the elderly were living in poverty.

Originally when it passed it was considered a retirement program that is part of the unified budget but paid for because there was more people paying into it than collecting on it.

Over the years there was expansion of the program to other areas that was not originally intended like disability or SSI or so on. Between the 1970 and 80's Congress voted to take the SS and several items off budget but use the SS surplus to net out the deficit spending which is why you only hear the net not gross deficit.

Congress, by law, directed Social Security and 213 other trust funds to give its surplus to the US Treasury in exchange for securities which is reported in the Intergovernmental holding portion of the debt as reported by the Bureau of Public Debt and has no impact on the financial market unless they start redeeming it. It was said that the baby boomers will start drawing on it way back in 1990's

Posted by: beeker25 | March 18, 2010 5:42 PM | Report abuse

Did you know that the HC bill does not even include paying for DOCTORS? Some insurance plan!

The CBO score is nothing more than an academic exercise if the cost of doctors isn't included.

This would all be hugely funny political theater, if we weren't in such deep trouble economically. While the US economy burns up, our glorious leaders fiddle with their make-believe money to build make-believe castles in the air. They do nothing but hasten our demise.

Posted by: dmarney | March 18, 2010 5:48 PM | Report abuse

If you're interested in how this bill will affect your health care (pro- or anti- bill), the most important section is Title IV (starts on p. 2020), entitled "IMPLEMENTATION OF BEST PRACTICES IN THE DELIVERY OF HEALTH CARE".

If you do nothing else, (1) understand what "best practice" guidelines are, and (2) decide for yourself how government established "best practices" will be used.

Posted by: Fletch_F_Fletch | March 18, 2010 6:36 PM | Report abuse

If they get it passed and it is the financial disaster that it appears it will be (government program estimates are ALWAYS too low), will the Dems apologize? Probably not, the same way Hillary never apologized for saying that her husband hadn't cheated and it was a right wing conspiracy (insulting all Republicans whether they are right wing or not) yet not apologizing when the blue dress showed up.

Posted by: Georgetowner1 | March 18, 2010 6:49 PM | Report abuse

I'm a very liberal democrat - an old-fashioned bleeding heart liberal democrat and have been since 1968. I have never voted for anything but dems.

And I am 100% against this bill and it astounds me that any real liberal would vote for it.

I utterly despise Obama for pretending to be for the public option, and then turning around and claiming he never said he was.

Therefore, I will never believe another word out of his mouth, including his pretense that he cares about people who have been screwed over by insurance companies.

Especially when this bill is just a huge gift to the insurance companies.

Tell me something, Ezra - why must we wait YEARS for so many of the bill's provisions to kick in? What is to stop insurance companies from jacking up their rates whenever they feel like it, just like they do now? Have you seen Obama try to do anything to STOP them from doing that, other than slapping their wrists? I haven't. So what if they have to spend 85% on health care? Please explain 85% of WHAT? They will just jack up their rates - again - as high as they want to make that 15% as much as they can.

But here's the bottom line. Obama said last night that it would "disrupt the process" - let me repeat that - DISRUPT THE PROCESS - to have REAL health care reform. Instead, he cares more about making sure the insurance companies get their limitless supply of blood money than he does about giving Americans the chance to obtain health insurance without being forced by MANDATE to pay through the nose to PRIVATE CORPORATIONS for a lousy product, courtesy of President Obama.

So, I will never support this "health care reform." It is little but corporate welfare. Which is all that Obama has stood for ever since taking office.

I predict Obama's next step will be to privatize Social Security and Medicare. Just watch. This is just the first step in Obama's campaign to privatize everything that has to do with health care, so his big business buddies can get in on the action.

It's sad that you are willing to settle for Obama's version of "health care" when the rest of the civilized world would not stand for treating its citizens this way.

Posted by: solsticebelle | March 18, 2010 7:09 PM | Report abuse

This is the quality of the opposition:
----------------------------
OBAMA PROMISES:

"THIS HEALTHCARE BILL WILL SIGNED BEFORE THE AUGUST(2009) VACATION".

"THIS HEALTHCARE BILL WILL BE SIGNED BEFORE THE END OF SEPTEMBER(2009)".

"THIS HEALTHCARE BILL WILL BE SIGNED BEFORE THANKSGIVING(2009)".

"THIS HEALTHCARE BILL WILL BE SIGNED BEFORE CHRISTMAS(2009)".

"THIS HEALTHCARE BILL WILL BE SIGNED BEFORE JAN 20TH".

"THIS HEALTHCARE BILL WILL BE SIGNED BEFORE THE STATE OF THE UNION ADDRESS".

"THIS HEALTHCARE BILL WILL BE SIGNED ON MARCH 18TH BEFORE MY TRIP TO ASIA".

"THIS HEALTHCARE BILL WILL BE SIGNED SUNDAY MARCH 21ST BEFORE NOON".

"THIS HEALTHCARE BILL BE WILL BE SIGNED...............................".
??????????????????????????????????????
???????????????????????????????????????
??????????????????????????????????????


AND COUNTING!!!!!!!


Posted by: jjcrocket3
-----------------------------
You just indited the Republican party of no!

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Posted by: maidishoes11 | March 18, 2010 7:38 PM | Report abuse

After HCR passes, we can improve on it. It would be almost ludicrous to rail against these much-needed reforms after millions of conservative Americans that couldn't afford health care and want health care, begin to privately benefit from it.

People that stand to benefit from these reforms are going to become quickly apathetic to the fear-mongering nay-sayers. When they go to the ballot box, they're going to ask themselves if this politician, or that politician, has done anything for me lately or not.

And the last I checked in the polls, the "Party of No" isn't scoring any points of confidence with the majority of Americans; the GOP's scoring lower than the Dems on Capitol Hill, right now.

Out of desperation to shore up their declining support, I'm sure the GOP will score some seats back in this year's November election if they ramp up their propaganda efforts to radical new heights.

All bets are off though, if any conservative, religious-prone conspiracy nut start getting desperate as the November Election date approaches -- and if even one of them displays anger and subsequent violence at a big public demonstration, it will make national (and possibly international) news. Hopefully it doesn't come to that, but it doesn't erase the fact that there's a lot of lone wolves out there on the radical right. I wouldn't put it past them to bomb a women's health care clinic, or try to target the President or Commander-in-Chief.

Posted by: sierrawren | March 18, 2010 8:23 PM | Report abuse

This bill will result in an enormous change in health care as we know it now. That is not to say it is good or not good,but to increase coverage, without any life time limits or caps, to add millions upon millions of people to insurance will dramatically increase costs. you can't add 50 million people to the rolls and not increase costs dramatically. Unless you implement extremely tough cost control measures.. and that means reductions in payments to providers, restriction on advanced tests and diagnostics (by the way the "virtual colonoscopy" that Obama underwent recently is not available to those who have Medicare as Medicare will not pay for it nor do they pay for the anesthesia that makes the procedure more bearable as they deem it unnecessary). what we need is a national discussion of what this 2700 pages means and what a change in healthcare means to everyone. we are going to get something shoved down our throats (all 2700 pages) that very few legislators have read and that is nhot yet available to the public to see. Why is this good and why is this necessary?

Posted by: pamm718yahoocom | March 18, 2010 8:56 PM | Report abuse

Jenn,

Please don't suggest that health care costs aren't being contained because of a failure of markets. As Ezra has written many times, the single biggest driver of increasing health care costs can be attributed to the tax exclusion written into law by the Federal Government during WWII. The Office of Price Administration and the National Labor Board established wage and price controls to control wartime inflation in a time of extremely tight labor markets. Instead of allowing wages to rise, these boards decided to allow the growth of fringe benefits to supplement wages and made them tax deductible.

Over time, the tax exclusion ended up wildly distorting the health care market in favor of employer provided health care. Employer provided health care "shielded" patients from the true cost of coverage and services.

The single most important thing that needed to happen in health care reform did not happen, the elimination of the tax exclusion.

And this legislation actually exacerbates those policy failures. Young healthy people will opt out, premiums will spiral upward, more will opt out until a much higher equilibrium price for premiums will be reached. It's possible that the premium price will continue upward so much that the system will literally collapse, unless of course the government continues to expand its subsidies. This legislation creates very high marginal tax rates for the poor and middle class. It creates strong incentives for small to mid-size businesses to drop coverage.

As you can tell, I am dubious about the CBO scoring. I expect this legislation to be many times more expensive than the CBO scoring suggests. I hope and pray I'm wrong. I fear that I am not.

Steve

Posted by: FatTriplet3 | March 18, 2010 9:01 PM | Report abuse

Oh yeah! The good guys headed for a win! Go Dems, go Nancy! Awin-win for the Amwerican people.

Posted by: dudh | March 18, 2010 9:15 PM | Report abuse

Kevin_Willis wrote: most of the left's complaints about the cost of Medicare Part D is that there were no corresponding increases in taxes. They want to raise taxes. Thus the complaint. If they raise or add taxes to "pay" for Medicare Part D, then they will consider all the problems with Medicare Part D "fixed". Because tax increases are the answer to everything!
------

Wait, I thought you right-wingers were supposed to be deficit hawks. I guess if Bush passed a program and paid for it all with deficit spending, it's OK.

Posted by: scientist1 | March 18, 2010 9:37 PM | Report abuse

Here's the actual math of the "$138 billion" in savings, if anyone's interested: Of the $138 billion saved in the first 10 years, $70 billion represents premiums collected for a new long-term-care program, money the government will have to pay in benefits later (aka, a new entitlement program). An additional $20 billion in savings comes from changes to the federal student loan program - and the savings are likely the reason that the Democrats attached the student loan bill to the health care bill, so the CBO score would look more appealing.

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Posted by: leiweiniliu | March 18, 2010 10:05 PM | Report abuse

Why are the "avatars of austerity" in the GOP against the largest deficit reducing bill since the one passed by the Democrats under Clinton in 1993? Surely they aren't hypocrites, maybe bought and spoken for, but hypocrites?

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Posted by: leiweiniliu | March 18, 2010 10:08 PM | Report abuse

Very good article.

There certainly is a lot of "noise" in our public discourse today. Thankfully I am able to see through it and still call things as I see them. And what I see here is good enough for now, given the people we have to deal with, but the bill will seemingly cement into place a for-profit health insurance industry that will be not only too big to fail but also a totally unnecessary waste of health care dollars. Essentially, thanks to the hijaaking of this entire bill by the insurance industry, American taxpayers will now on one level be paying the insurance companies' investors!

These are, after all, publicly traded companies. Their investors' profits will be on all our backs. And it will be next to impossible now ever to get them off.

Posted by: GeorgHerbet | March 18, 2010 10:24 PM | Report abuse

Dude, you are such a cheerleader. Don't call your self a journalist. The CBO estimate was preliminary and the books are being cooked. Obama is raiding Medicare and the taxes start Monday but no benefits until 2014. We are being raped. Report that.

Posted by: DaMan2 | March 18, 2010 11:10 PM | Report abuse

Thank G-d for the CBO... If it wern't for it the country would most probably be in a real financial mess!

Posted by: nemosnemesis | March 18, 2010 11:20 PM | Report abuse

Might it be possible that those who don't want this to pass are afraid that the bill won't simultaneously raise Stalin and Hitler from the grave, but instead might turn out to be something the public actually likes? I mean, GOP, if it's so bad, then you guys will storm back into power and repeal it, right? And you'll be heroes. Right? Oh, I guess that it wouldn't quite work out that way, now would it?

Posted by: sgoering | March 19, 2010 10:59 AM | Report abuse

What no one seems to mention is the fact that if this healthcare bill passes on Sunday and is ratified by the Senate and signed into law by the President, Collection and taxes to pay for it will go into effectimmediately. If you have health care now, you will have to continue paying those premiums for at least four years until the coverage will actually go into effect. Similarly, those without healthcare now, because they can't afford it,
will have to start paying into a system which will not give them any benefits for four years. What a great deal!

Posted by: depoulins | March 19, 2010 4:08 PM | Report abuse

...AND IF IT DOSEN'T CUT COST, MAYBE WE WILL CONSIDER CUTTING THE DEFENSE BUDGET BY GETTING RID OF SOME OF THOSE UNNECESSARY BASES ALL OVER THE WORLD LIKE JAPAN AND GERMANY AND CUTTING BACK ON AID TO ISRAEL.

Posted by: thelma1 | March 19, 2010 7:33 PM | Report abuse

Why are any of you thinking that anything run by the government will be good - efficient - how is Social Security doing these days? Hows Medicare, Medicaid doing? Been to the Post Office lately? I've never spent $300 on a hammer or $600 on a toilet seat before. But for some reason people actually put their trust and faith into this as the ONE. This is it, the others, well they went bad, yea thats it. What! all of a sudden the government gets it? and now magically knows how to do something.

If I go to McDonalds and buy a meal for my family it'll cost about $15 if I go in and buy a meal for everyone in McDonalds it'll now only cost me $6 or $7? How is that?

How very scary that people actually believe this.

November is coming....

Posted by: RWEB | March 22, 2010 4:29 AM | Report abuse

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