Last week, I noted that Senate Democrats are now intent on rushing through a budget-busting "fix" to Medicare doctor reimbursements. The fix would cost about $240 billion, but wouldn't be paid for. By passing this as a separate bill, apart from broader health-care reform legislation, Senate Democrats get to maintain the fiction that health-care reform will be deficit neutral.
As legislative scams go, it's pretty obvious — pass a bill on the promise of future savings, then "fix" those savings later when they prove unpopular. But given the clout doctors have with Congress, there's a good chance it will work. Indeed, as John Dickerson explains, similar forms of promised-savings scams, in which Congress swears it will save money and then reneges at the last minute, are depressingly common in health-care policy:
When the Congressional Budget Office determined that the Senate finance committee's health care legislation would not add to the deficit, reform supporters heralded the news. Further, said the CBO, the bill would meet another important Obama priority: It would start to chip away at long-term health care costs. Budget watchdogs were skeptical, though. Former CBO director Douglass Holtz-Eakin was even more so. "What they're saying is: 'Your fantasies add up. I could say to CBO: 'Hi, I'd like to make 5 million a year and live in a 125-room mansion. Does it work?' And CBO says 'yes,' but that isn't going to happen."
The former policy director for the McCain campaign, now with the Manhattan Institute, wasn't quibbling with the CBO's math. He just didn't think future politicians would keep the promises the bill was holding them to. According to one proposal, for example, if health care savings don't materialize in the coming years, automatic cuts in health care funding will kick in. Holtz-Eakin, not unreasonably, sees this as unlikely. Budget experts also worry that Congress will not reduce payments to providers as scheduled or follow through with planned Medicare cuts.
Basically, the problem is that, when scoring bills, the CBO can't throw legislation back at Congress and say "bullshit" — even when everyone knows that that's all that Congress' proposed savings are.