An Open Letter to the Men and Women Over at the CBO--Hang In There!
Last November I did a post: To the Congressional Budget Office: Please Keep Playing it Straight!
In it I said:
I hope the CBO doesn't cave to political pressure and keeps doing its non-partisan down-the-middle job.I also said:
If I hear the politicians whining and the special interests squealing about CBO's conclusions about how these cost containment "lite" proposals...don't save much money I know the CBO pros are doing their job.
It looks to me like the nebulous "pay-for-performance" initiatives often proposed as part of Medicare physician payment reform are too often ways of avoiding the really heavy lifting that has to be done to fix that doc payment system. Since no one seems to agree on what quality is and a way to measure it I don't have a lot of faith there are big fixes here. If all of the docs are enthusiastic about pay-for-performance proposals in exchange for avoiding fee cuts you know it isn't accomplishing a lot!So, six months later lawmakers are sending one of these "cost containment lite" proposals after another over to the the CBO and the CBO is sending them back stamped, "insufficient funds."
Wellness programs very similar to the ones we see today were around in the late 1980s and never accomplished a lot.
Health information technology progress and patient medical records are very important--particularly for improving quality--but have a lot of upfront costs and take years to payoff. Ask any doctor now struggling with them.
The disease management and coordinated care programs now being proposed are, like most cost containment "lite" proposals we are seeing today, helpful but only incremental extensions for what is going on in the market anyway. No silver bullets.
And there's lots of whining about it now going on atop the Hill where people are desperate to find easy money for health care reform.
It will take more than $1.2 trillion to pay for health care reform and the Obama budget cuts have only identified about $300 billion toward that goal.
We will not reform the health care system unless we really reform the health care system.
The only thing standing between BS reform and real reform are the men and women--real men and real women--over at the CBO.
Proud of you.
Hang in there!!!!
3 comments:
I'll repeat a question I've asked several times, but have received no response (which may answer the question): How accurate is CBO scoring? Has anyone done an analysis of how accurate CBO's estimates turn out to be?
Can you even say that they have $300 Billion? Doesn't the administration's back door cuts to the Medicare Advantage program in the 45 day notice (by not taking into account the likley doc payment fix in rate setting) aleady use up some of the projected $175 billion in savings over ten years?
Bob, you say "It will take more than $1.2 trillion to pay for health care reform."
What does this estimate mean? I assume it is a ten-year projection, but is it the increase over current non-reform projections? Is it total national health care spending? Is it federal health care spending? Or what?
And what is the source of the $1.2 trillion number? If it is the 2008 Lewin estimate of the Obama campaign proposal cost, the net federal expenditure increase over 10 years was projected to be around $1.2 trillion, but the net national expenditures were estimated to decrease. Later Lewin estimates for the Commonwealth Fund show different numbers, also.
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