Wednesday, February 11, 2009

The "Cleanest and Strongest Lever" to Make Health Care Reform Work

I like the Congressional Budget Office (CBO). In a town where self-serving BS generally pollutes the health care reform discussion these guys regularly play it down the middle. Are they always right? I suppose not. But they play the game on the up and up and that makes them noteworthy.

Their latest contribution came from Director Doug Elmendorf. In Congressional testimony he said that, "The cleanest and strongest lever that [the Congress has for] private health care [reform] is the tax exclusion. Many analysts would agree that adjusting that exclusion can be very beneficial for health insurance coverage and for ensuring a more efficient health care system." He went on, "In the public sector...the comparably clean and strong lever would be increasing cost-sharing by Medicare beneficiaries."

His comments came during testimony where he told Congress that the number of those uninsured would reach 54 million in ten years if we do not fix the system.

Now this suggestion certainly wasn't music to the ears of Democrats that have generally avoided things like health care tax reform and cost sharing but it was an honest appraisal of just what it is that will do a lot of the heavy lifting that real health care reform will require.

Last December, the CBO published a list of 115 health care reform options and their impact on long-term federal spending--another stellar job by them. In a post summarizing their findings, I said that it was clear from their work that making the health care system affordable would mean having to deal with what and how we pay providers and beneficiaries--the politically problematic part of meaningful reform. This latest testimony just underscores that conclusion.

Is there any support in the Congress to actually deal with the long-standing tax exclusion for health benefits or entitlement cost sharing? Just a few days ago a bipartisan coalition of 13 Senators from Lindsey Graham to Joe Lieberman to Ron Wyden announced they were reintroducing the "Healthy Americans Act."

Will the Congress and the administration be so bold to actually tackle these kinds of far-reaching goals?

At least the CBO and 13 Senators appear ready.
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