CBO Health-Care Score Assumes Congress Sticks to Its Promises, Which Probably Won't Happen, Says CBO


The House released its health-care reform bill yesterday morning, and by afternoon, the Congressional Budget Office had released a score. The big headline estimate is that the bill would result in a net reduction of the federal deficit by $104 billion by 2019, and that the bill would continue to slightly reduce the deficit over the following decade. But as always, the real story is the passage at the end of the CBO's summary:

Those longer-term projections assume that the provisions of H.R. 3962 are enacted and remain unchanged throughout the next two decades, which is often not the case for major legislation. For example, the "sustainable growth rate" mechanism governing Medicare's payments to physicians has frequently been modified to avoid reductions in those payments, and legislation to do so again is currently under consideration in the Congress. The bill would put into effect (or leave in effect) a number of procedures that might be difficult to maintain over a long period of time. It would leave in place the 21 percent reduction in the payment rates for physicians currently scheduled for 2010. At the same time, the bill includes a number of provisions that would constrain payment rates for other providers of Medicare services. In particular, increases in payment rates for many providers would be held below the rate of inflation (in expectation of ongoing productivity improvements in the delivery of health care).

This is about as strong a warning as I can imagine coming from the extremely reserved and cautious CBO, and it essentially amounts to the office saying (once again) that the only way this bill might prove deficit neutral is if it's followed to the letter—and that's unlikely to happen.

The American Spectator's Phil Klein has more analysis here.

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  1. It would have been totally awesome if the far left hand letters in this paragraph had read “You’re fucking liars, Congress, and this bill’s scoring is bullshit.”

    1. Actually, it would read “You’re fucked.”

      1. More like “We are all fucked” (it’s ahrd to start a line with an apostrophe).

  2. It’s unlikely the far left will hand out letters like that, prolefeed.

    1. The CBO is run by “the far left”?

    2. The CBO isn’t far left. However, a certain thing about biting the hand that feeds you comes to mind.

      The CBO is pretty honest, but they are employed by Congress, so there’s a limit to how much they can call bullshit on something the Congressional leadership is pushing.

  3. When the CBO projections for the first bill came out, the CBO refused to make any predictions after 2019 because it was too unreliable.

    I guess the standards have changed…

    Or the politicians supporting the bill made some threats…

  4. prole, that type of coordination is probably too much for Arnold’s secretary to handle. They’re a government employee, after all.

  5. “reduction of the federal deficit by $104 billion by 2019”

    It’s frightening enough that the deficit is so high that there’s $104 B to lose, and simply amazing that it’ll hardly put a dent in the deficit.

  6. Hell, the deficit could disappear by 1/1/2010 if the government just confiscated 100% of private assets.
    Doesn’t mean it would be a good thing, however.

  7. Of course the CBO has perfect record of abysmal failure in projecting the future costs of every existing entitlement program at inception.

    Anyone who thinks the CBO has suddenly gotten a lot smarter this time around is delusional.

  8. Why do they need to tweak the health care system? It’s working just fine, isn’t it?

    1. Why do they need to tweak the health care system?

      The part that the government is involved in. They need to get out.

      Now, troll, be gone with you.

      1. Did it ever occur to you that Medicare exists because private industry has absolutely no interest in covering people who require the most health care?

        No, I imagine it didn’t.

        1. Believe it or not, services require money to pay for them.

          If you have serious health issues, maybe you should cancel the premium cable deal with 800 channels you just bought, and save that money for your medical care.

          1. So you’re saying getting old is a pre-existing condition.


            1. I never called anything a pre-existing condition.

              Logically, I plan on getting old. Logically, getting old comes with its own set of problems, health care being one of them.

              If I know this ahead of time, as I’d think most people do, I would make plans so that my life didn’t depend on the charity (voluntary or not) of others.

              1. Exactly how much do you save in your magical libertarian fantasyland?

                Do you know exactly what condition/surgery you’re going to get, and can prepare accordingly?

                I assume you’ll be refusing Social Security and Medicare on principle, of course.

                1. He is paying premiums into SS and Medicare, you nitwit, and is entitled to receive benefits. Libertarian principle doesn’t claim otherwise.

                  Stupidity seems to be a pre-existing condition for a retard (lib or not) like you.

            2. No. He assumed you were talking about pre-existing conditions, not getting old, since it would be ridiculous to assume that private insurance companies wouldn’t be willing to make a profit off charging average old people for insurance using actuarial tables.

        2. Yeah, OK. Because private industry hasn’t been offering Medicare supplement plans for several decades or anything.


          1. Medicare supplement plans clearly /= Medicare.

            Watch who you’re calling moron, moron.

            1. Medicare supplement plans clearly /= Medicare.

              And Medicare Advantage plans, which replace Medicare?

            2. Medicare Advantage plans replace Medicare. Insurance companies are willing to provide them in exchange for the money that the government provides, and make a profit doing so. Insurance companies aren’t forced to sell these, but they’ve been jumping in eagerly to do so and make a profit.

              Do you think that they would refuse to sell the same plans for the same amount of money if the money were coming from private funds instead of the government?

              If you complain that seniors wouldn’t possibly have the money to pay for the insurance plans that the government is paying for on their behalf, perhaps it would be different if their Medicare taxes had actually been saved in an account like an HSA to pay for when they were old instead of being passed on to the next person down the line in a pay-as-you-go Ponzi scheme style system.

    2. Why do they need to tweak the health care system?

      When does overhaul = tweaking? Try again troll.

      1. Gosh, maybe you libertards could get elected on the basis of your personal insults. You don’t seem to be very good at actually countering criticism.

        Well, you guys are fundamentalists; not sure what I expected.

        1. No. We can’t get elected because people over time have been extremely willing to give up their freedom because someone told them that others will pay for their shit. Not only that, but you don’t even have to be responsible any more. People with shitty principles agrred to it hook, line, and sinker.

          1. It’s a CONSPIRASUH!!!1!

            Not very bootstrappy of you guys. Seriously, get to work and form a viable third party, already. It’s been 40 years.

        2. Give me a break you hypocrite. I’m sure you didn’t mean “LiberTARDian” to be an insult to anyone right? Come back when you have something insightful to say.

        3. ROFLMAO

          That’s funny, you calling out other people for “personal insults”.

          Thanks for the laugh.

    3. Where do you people come from?

      No the system isn’t working fine. Look at the history of government involvement in ANYTHING. That should tell you all you need to know about government when it decides to stick its nose in something.

      I go to a great deal of effort to make sure that I’m healthy. Very few people in this country do that. If the government gets into health care, I’m going to end up paying for all the medical procedures, costs, and operations of some 500 lbs. dumb fuck who doesn’t have the self respect to make better choices about what he shove down his throat.

      The same goes for smokers. You have a right to smoke, just like you have right to eat whatever you want (and become a 500 lbs. dumb fuck if you want). But you have no right to take my money to solve your problems.

      1. Um, James, I hate to tell you, but you already pay for that guy, in the form of increased premiums because that guy went to the emergency room and didn’t have insurance, so the hospital/doctor/insurance company raised their rates to make up for the loss. This overhaul is supposed to change that.

        And the government has a role in plenty of things that make us happier and safer. I mean, can you imagine if the police force were completely private? “hello, this is 911, which card will you be using today?”

        1. The solution to this problem, of course, is to push the fat bastard out into the alley at let him die the ugly death he so clearly deserves.

          1. First of all, I have nothing against short people – I think they may actually be more efficient.

            As for the fat bastard who may deserve to die…

            Your parents may be large people. You can be genetically pre disposed to be more heavy set than other people.

            Being fat, for the majority of the population (there are exceptions), is the result of life style choices.

            If you only eat at McDonalds, and choose not to exercise – things that are proven to lead to being fat – you should face the consequences of your choices without my sympathy or involuntary tax dollars to keep you alive.

            If you make the choice to do meth, it is neither my job, nor the government’s, to come to your rescue. Why would it be any different for other life style choices?

            Charity is great, but it’s not mandatory.

        2. So I pay through my taxes now instead of higher insurance premiums. How exactly am I any better off?

        3. The only way to avoid that is get to rid of health insurance all together. So, if you had to have a medical procedure done that was very expensive, you’d probably go to a bank and take out a loan.

          The mandatory system the government is suggesting would only amplify the problem.

          “This overhaul is supposed to change that.”

          This wouldn’t change because HI companies would be REQUIRED to offer policies to EVERYONE, so the total cost would just be spread across all the clients anyway.

          It’s just like with taxes. If the government taxes a company, the company raises its prices to keep the same profit percentage and the cost is passed on to the customer. The HI companies will want to keep the same profit percentage, so they will hike up everyone’s dues to maintain that.

          Public protection is one of the legitimate uses of government going all the way back to the first social contract. It is also a service we pay the government for, thru taxation. If you read enough on this website, you’ll see that even this service has its issues.

          1. The only way to avoid that is get to rid of health insurance all together. So, if you had to have a medical procedure done that was very expensive, you’d probably go to a bank and take out a loan.

            I’ve been trying to figure something in my head, and maybe you can help me out, yeah? When a person is insane, as you clearly are, do you know that you’re insane? Maybe you’re just sitting around, reading Guns & Ammo, masturbating in your own feces, do you just stop and go, “Wow! It is amazing how fucking crazy I really am!”? Yeah. Do you guys do that?

            1. What is so crazy about paying, with my own money, for a good or service that I require?

              Health insurance companies, like banks, operate off of the laws of probability.

              It’s statistically unlikely that every client of a HI company will need a quadruple bypass at the same time. It’s also statistically unlikely, that a bank’s clients will all withdraw their money at the same time – allowing the bank to invest and offer loans.

              If health insurance companies did not exist, I wouldn’t be paying for their overhead or profits. If I simply went to the bank and got a loan, it may well be cheaper depending on the interest rate and how long I take to pay it off.

            2. Also, on another article, weren’t you getting all insulted and complaining about how libertarians don’t confirm to proper, polite debating technique?

              For your information, I was on the debate team, and I missed going to the national tournament because I made the girl I was speaking against cry.

              1. I used a quote from the movie Seven for comedic effect. Calm down.

                Again, the problem with Libertarian Fantasyland is that not everyone follows libertarian doctrine. Not very many people (libertarians included, I’m quite sure) would qualify for a loan of that magnitude.

                So, in Libertarian Fantasyland, they’re fucking dead. Nice place.

                1. Yes, the movie Seven was a real knee slapper…

                  If you don’t spend money you don’t have, it’s too hard to have a decent credit rating…

                  If only government would stick to that principle…

                2. The person spewing progressive talking points is complaining that people here are too doctrinal.

                  Also, clearly you haven’t been trolling here long enough. Wait until foreign policy, morality or religion come up. Far more diversity of opinion here than the Huff post.

            3. Not only does he troll… he plagiarizes too.

              1. I’m pretty sure you don’t know what “plagiarizes” means, chief.

                I’m gonna extrapolate that to your brain power in general and most likely be correct.

        4. Um, James, I hate to tell you, but you already pay for that guy, in the form of increased premiums because that guy went to the emergency room and didn’t have insurance, so the hospital/doctor/insurance company raised their rates to make up for the loss. This overhaul is supposed to change that.

          Those charges are a tiny percentage of premiums. Repeated studies in independent medical journals have cast cold water on the idea that big savings would be available from avoiding that, just as they’ve disproved the idea that more preventative care will save us all money.

          Those claims are simply not reality-based. They’re based in Hope, not facts. (Just like the overeager claims that malpractice reform would solve everything, instead of making small changes at the margin.)

      2. Don’t worry James. Banning smoking and fattening foods is the next step.

        1. By all means, keep smoking and bad foods around.

          Just make me pay for all the health problems they cause.

          1. Just *don’t*

            Wow, that was a terrible word to leave out

  9. Shorter CBO:

    “We’re obligated to score this bullshit, but we’re not obligated to refrain from calling it bullshit.”

    1. Yeah, really. Trying to predict what these loons in Congress will be spending years down the line is like trying to predict which kid John Wayne Gacy is going to kill next. It just can’t be done with any reasonable expectation of accuracy.

  10. We all know how this is going to work.

    They will create a massive one size fits all monstrosity where a few will be helped, but most will see a steady drop in quality. It will cost 3 times as much as promised and when the depth of the disaster starts to set in, they will blame the GOP and demand we spend another trillion or 2 to “fix” it. The GOP will kick in only 500 billion stupidly thinking they can buy some love from the lefty media.

    Rinse. Repeat.

  11. Libertardian: “Did it ever occur to you that Medicare exists because private industry has absolutely no interest in covering people who require the most health care?”

    That’s correct. Prior to 1965, people dropped like flies the moment they turned 65. No doctor would ever see an old patient back then until govt made them. (sarcasm off)

    Government programs exist because people use government power to take from one person to give to another. Medicare was a way for Democrats to take from working americans and lock in older voters to their party by giving them someone else’s money. they keep running out of someone elses money and so need to jack up taxes.

    … When a person does it, its stealing. When Government does it, its socialism.

  12. “Exactly how much do you save in your magical libertarian fantasyland?”

    I think people should be taxed according to their ideology – conservatives and libertarians should be taxed at a flat 15% and liberals/leftists at a ‘progressive’ 70%.

    The conservatives/libertarians have to take care of their own retirement and healthcare, but can do so with the money saved on taxes.

    The leftists get to go to a community ‘clinic’ for healthcare, with all the advantages and advanced technology that can be obtained from a stellar example of how it is supposed to work … Cuba.

    Call it the socialism opt-out plan.

    Funny, but no leftist has taken me up on the offer.

  13. This thread is an example of why threaded comments are superior. I was able to skip not only ‘tardian ‘s comments, but also the comments of those feeding him.

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