• All CBO score fighting, all the time

    OK, maybe a few other things besides how the CBO scored health reform are being discussed. But it sure doesn’t seems that way. Must we witness another debate on these points again (among others)? I guess so.

    On just that, Jonathan Bernstein disagrees with my take on the CBO’s estimates. And I agree with him disagreeing with me. Here’s him, first quoting me, and then in his own words:

    What interests me, however, is a different argument from Austin Frakt that his entire dispute about CBO scoring “misses the most important message conveyed by CBO estimates.” That is:

    Here’s the state of the debate over these CBO health-reform estimates: which is right, the baseline scenario or the alternative fiscal scenario? It’s the wrong question! It doesn’t matter which scenario you think is right. Likely neither is when examined in any detail, and both are horrible in broad sweep. Choose your poison: massive taxation or massive debt.

    Actually, though, there’s a third option: recognition of the underlying problem and dealing with it.

    The problem is health care costs. They’ll cause budgetary distress with or without health reform. The CBO’s estimates, both of them, show it clearly. Health care costs have been the source of budgetary woes for decades, and there’s no end in sight under any realistic scoring of any serious health reform proposal.

    I understand Frakt’s point, but I think he’s wrong. Yes, it’s quite true that reformed health care is still producing enormous projected future budget deficits. Indeed, that’s just the most obvious problem; it’s an even bigger deal that health care costs threaten to swamp the rest of the economy, which can’t possibly be a good thing.

    I guess the question to ask is whether the problem with health care and future budgets is a policy question or a political question.

    That’s a very good question. The answer is “both.” Bernstein goes on to make an excellent case for the political relevance of the debate over the CBO’s estimates. He’s right. Go read it.

    And then there is the policy. We don’t have good, sustainable health care policy. Moreover, nobody has proposed any alternative that is both politically feasible and likely to do a substantial amount of good. It’s easy to find things that everyone can agree on–at least in principle–that don’t make a dent in health care costs or change things very much. It’s also easy to declare, “Thou shall not raise spending more than GDP + 1 percentage point,” but you’ll not likely get very many successive Congresses to agree to meet that goal.

    When considering a point of debate, I always find it instructive to adopt the assumptions of the opposition and ask, “Then what?” In this case, it doesn’t matter which side you call the opposition. If you adopt its assumptions about the CBO estimates or, in fact, either of the set of assumptions the CBO itself used in two alternative long-range projections under health reform (or, as it turns out, even without that reform), you arrive at the same, horrifying fact. Health care costs are the problem, not how the CBO scores bills. That was my point.

    For evidence, you can look at the charts I posted. For another way to see it, look at the chart in Jonathan Chait’s recent post, which he credits to Ezra Klein. See a big change in health care cost growth between the pre-reform and post-reform lines? Not really? Well, it’s there, it’s just tiny. It is some consolation that it ends up going in the right direction (after some gyrations), but, still, it’s a tiny change. It hardly does the job. That’s not the fault of the CBO, the ACA, the Democrats, or the Republicans. It’s a massive, collective, multi-generational failure.

    Perhaps Bernstein is right, that a first, necessary, step is to stop second guessing the CBO. I concede that. But, let us ask, “Then what?” It’s a good question. Got an answer? Do either of our political parties?

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