How Much Does A Decade of Health Care Reform Cost? It Depends on What You Mean By "First Decade."

When the Congressional Budget Office scores a bill, its looks at the budgetary effects over the immediate ten year window. So on the health care bill, the headline cost of $849 billion covers the period between 2010 and 2019. Problem is, it's a misleading figure since most of the new programs don't actually kick in until 2014, and, as a result, most of the spending—99 percent, according to the CBO—doesn't occur until the final six years. That means it's not actually a very good reflection of how much it's going to cost to run the bill's new programs over a decade-long period.

Think of it this way: If you decided to add the cost of a gym membership to your budget next year, at $100 a month, it would cost you $1200. But if you decided to wait until July to join, the cost would only be $600 in next year's budget. Cheap, right? Well, not really, because the following year, and every year after, the membership would cost you the full $1200. That's basically what Democrats are doing here: Holding off on implementing the bulk of the reform's new programs and new spending in order to make the initial total seem less expensive.

So what sort of numbers would you see if you started the score in 2014 and added up the first decade in which all the parts of reform are actually in full effect?

The Pacific Research Institute's Jeffrey Anderson did just that, and, not surprisingly, the totals are a lot higher:

In other words, according to data provided by the CBO, starting up the entire reform apparatus is going to cost more like $1.8 trillion over its first real decade of operation.

(Chart via the Republican Congressional Health Care Caucus.)

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  • Ira||

    You have $1.8 BILLION at the bottom (which is a pretty good deal for shitty legislation). Obviously you meant $1.8 TRILLION!!!!!!!!!!!!

  • Old Mexican||

    In other words, according to data provided by the CBO, starting up the entire reform apparatus is going to cost more like $1.8 billion over its first real decade of operation.

    Lies! Calumnies! We need this healthcare reform bill because, otherwise, the Globe is going to warm and whole cities will be underwater!

    Oh, wait . . .

  • Peter Suderman||

    I know! I fixed it. Thanks though.

  • ||

    In the Vietnam War, these kind of estimates were called "WEGs" = "wild-eyed guesses."

    What's the over/under that it tops $2T before the Jan 1, 2020?

  • Sean W. Malone||

    Only 2? I know it's only 10 years from now, but Iraq & Afghanistan have cost some 5-6 times their estimated costs, right? Let's make a real bet and go for an over/under on $5 Trillion by 2020!

  • ||

    Over. I'll bet my life savings on it. It'll be worthless in the coming inflation anyways

  • Old Mexican||

    But we need this bill so that the USA can be equal to other industrialized countries that provide healthcare for their citizens - that is, equally broke.

  • Xeones||

    Yo, statistics are racist. Why do you hate Hope, Suderman?

  • pancakes||

    lol how are stats racist?

  • ||

    Since he's not here to defend himself...

    Episiarch back in his modeling days.

    This was before, the, uh, accident.

  • Art-P.O.G.||

    Oh man tell me they still sell those somewhere...please...

  • Dr. Thaddeus Venture||

    That, is a "speed suit". All boy-adventurers-turned-super-scientists wear them.

  • hmm||

    Don't worry. By then Obama will have fixed everything.

  • jester||

    'dragging themselves through the negro streets at dawn looking for an angry fix,'

    RACIST!

  • hmm||

    are you stalking me?

    You know it's not nice to pick on the short bus kids.

  • jester||

    You mean you're not a hot, leggy, brunette. Cancel the restraining order, you don't need it.

    (Disclosure: really, I woke up wanting to quote something by Allen Ginsberg and by accident it worked after your comment)

  • hmm||

    I am a hot leggy brunette.

  • jester||

    mmm,hmm! you know dat's right!

    RACIST!

  • hmm||

    legs are a tad hairy though.

  • Old Mexican||

    Congress: So you see, we told the truth, from a certain point of view.

    Joe Q Public: A certain point of view?

    Congress: Joe, you will find out that many of the truths we hold depend on our point of view.

    Joe Q Public: What? That doesn't make any sense!

    Congress: Well, not to you because you're too stupid to understand - which is why we rule over you. We know what's best and you don't. So, there.

  • robc||

    Im not sure why articles like this matter. Those who support the health care scheme dont really care about costs. Those that oppose it know the cost estimates are all bogus anyway.

    Who does this kind of thing change the mind of?

  • ||

    Combine that estimate with the fact that the first 15 years of Medicare cost nearly nine times what was estimated, and it should scare anyone with half a brain.

  • jester||

    but, but, but...this will SAVE money because now everyone will have insurance and they won't have to clog up super expensive ERs.

    Now that everyone has auto insurance, it's super cheap, there are no more worries about uninsured motorists driving away from the scene.

    If Bush didn't hate black people, he would have mandated everyone in the US to buy flood insurance. And with inevitable AGW and the seas all rising like crazy, we all really need it. I could go on but I don't want to steal all the spotlight from...

  • ||

    David Broder, and maybe some tiny part of the "sensible center" that follows him.

    No seriously. He wrote a column recently where he talked to all the sensible centrist budget experts who admitted this and other budgetary problems with the bill like the fact that it doesn't do anything that the Administration or Congressional leadership claims on costs. This worried him.

    So, there's that going for us, a worried David Broder.

  • Jersey Patriot||

    It's important to document these sorts of transparent lies, so that next time we can...we can...aw hell.

  • ¢||

    Who does this kind of thing change the mind of?

    Nobody.

    But it's important to some people that they be seen as expert in "policy" or, failing that, impressed by numbery-lookin' things.

    Calling bullshit on the whole show is a flyover gaucherie (formerly known as philosophy).

  • Johnny Longtorso||

    What choice did the Dems have? They had to hide the incline.

  • ||

    Threadwinna!

  • Mike McMack||

    ... as the Republicans had to hide the incline for the cost of invading Iraq, and Afghanistan. Recall Mr Bush saying, with a straight face "It wont' take long, and it won't cost much". Geez, Im glad Im neither a republican, nor a democrat, they are both such useless fools.

  • jester||

    "'it should scare anyone with half a brain.'

    But if you have all of your functioning brain you would understand what a good deal this is. Lobotomies have a side effect of making people into rightwing nutjobs."

    -excerpt from the new book "How to win arguments and influence people" by Chud

  • Mike McMack||

    Jester: telling everyone "You'll all be covered, don't worry your little head about the costs, Big Brother will take care of everything, just don't look behind the curtain", is as much a lobotomy as claiming that invading iraq and afghanistan were good things that will "help us", and "protect our constitution".

  • Gilbert Martin||

    Let's also not forget that the CBO has never been proven right yet in predicting the cost of any entitlemnt program.

    So even if the bill had been engineered where the taxes and benefit payments started in sync, producing a higher 10 year cost number, you can rest assured that the REAL 10 year cost number would STILL be far higher than the original estimate.

  • Mike McMack||

    Bravo, Gilbert, NEVER.

  • Spartacus||

    That's basically what Democrats are doing here: Holding off on implementing the bulk of the reform's new programs and new spending in order to make the initial total seem less expensive. until after Obama is safely re-elected.

    Fixed that for you. No need to thank me.

  • Mike McMack||

    As was the Republicans scheme to continue telling the American voters how wonderfully things were going in Iraq and Afghanistan (how many "Job done!"'s did we hear up to 2004). Both parties are completely broken beyond repair.

  • Rich||

    Boy, did the Dems blow it by not waiting until 2020 to have the new programs kick in!

  • ||

    Of course since the cuts to the budget deficit also increase with time, then the net cost to the government will in fact be smaller if you pick the latter period. On the other hand, if you insist on pretending that the bill has no revenue raising measures, then I guess it seems expensive.

  • Gilbert Martin||

    If you pretend that "revenue raising measures" (aka taxes) are not an expense to the public then you can't calculate the cost of anything.

    It's the spending, stupid. And not only the direct government spending but the cost of all the insurance mandates for pre-existing conditions being covered at no additional premiums, etc. that drives up the costs for the general public via increased premiums for everybody.

  • ||

    Of course since the cuts to the budget deficit also increase with time, then the net cost to the government will in fact be smaller if you pick the latter period.

    The cuts that are just like the ones that Congress is refusing to let happen now, and are just like the mammogram recommendations that are being repudiated by HHS Secretary Sebelius?

    For the House bill, I know that it doesn't matter; the back half of the House bill was still worse. I believe it's that way for the Senate bill, but in any case it's no better.

    Keep believing in your comfortable lies.

    On the other hand, if you insist on pretending that the bill has no revenue raising measures, then I guess it seems expensive.

    Any "revenue raising measure" included here is one that makes it harder to close the existing enormous deficit. We can assume that all the easiest taxes will go in this measure. This bill makes it impossible to close the existing deficit by raising taxes on "the rich" by using so much of that revenue for this purpose.

  • ||

    Of course since the cuts to the budget deficit also increase with time, then the net cost to the government will in fact be smaller if you pick the latter period.

    What cuts the budget deficit? The imaginary ones that assume that Congress will suddenly start slashing payments to providers and benefits to voters?

  • Mike McMack||

    Heh, heh, thanks RC, I needed that.

  • ||

    One comment. You state "most of the spending—99 percent, according to the CBO—doesn't occur until the final six years." That graph clearly states otherwise.

  • ||

    How so? It looks to me like there is virtually no spending for the first four years (2010-2013), and then it takes off like a rocket.

  • ||

    It says 99% of spending is in the FINAL SIX YEARS, or 2018-2023. While I agree there is hardly any spending in 2010-2013, the plan purports to spend roughly $450 billion from 2014-2017.

  • Greg D||

    It's referring to the final six years of the ten year window actually used in the CBO estimate (2014-2019)

  • Alice Bowie||

    I LOVE THAT GRAPH

    IT's BEAUTIFUL

    WHERE WAS THAT GRAPH whey Bozo was spending $11Billion Per year for Iraq?

    Not to mention what we are goin' 2 spend 2 rebuild it ???

    ASSHOLES!!!

  • Alice Bowie||

    My Mistake...It was $11Billion PER MONTH

  • The Libertarian Guy||

    Oh, shut up. Overspending isn't okay, no matter which party does it.

  • ||

    Well, Dorothy, you, toto, cowardly lion, and tin man can all go hang out with your straw men.

  • The Libertarian Guy||

    To whom are you directing this comment?

  • ||

    WHERE WAS THAT GRAPH whey Bozo was spending $11Billion Per year for Iraq?

    Well, the thing is that the health care bill is going to go on forever. That spending doesn't stop after 10, or even fifteen years. Let's call it a hundred.

    OTOH, the good thing is that President Obama's going to get us right out of Iraq so we won't be spending any more on it, right?

    So if you believe Obama, the health care spending is much more of a concern, since he's going to get right on pulling out of Iraq immediately.

  • ihealth 360||

    When the Congressional Budget Office scores a bill, its looks at the budgetary effects over the immediate ten year window. So on the health care bill, the headline cost of $849 billion covers the period between 2010 and 2019.

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