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March 3, 2009


Dr Steve B, Daily Kos - According to Congress Daily, Baucus, other lawmakers, and "some special interest groups have not been particularly pleased with what they view as CBO's conservative scoring of some supposed cost-cutting efforts that are needed to help offset the enormous price tag" of overhauling the health care system under the Baucus plan.
Baucus said if healthcare reform is to pass, the CBO needs to "get ever more creative to find … pathways to get the savings that we have to have."

Baucus told the head of CBO at last Wednesday's hearing that the Congressional Budget Office will play a significant role in efforts to overhaul the U.S. health care system because the agency's cost assessments will "make or break this enterprise," CQ Health Beat. Experienced observers assert that this is Baucus' way of pressuring the agency to come up with figures to justify the kind of healthcare reform Baucus wants. Similar pressure in the extreme was placed upon the CBO in the early 1990s when the Clinton health plan was being debated.

The CBO is responsible for "scoring" any legislative proposal for its true costs and savings. CBO has been recognized for the accuracy of its findings and projections and for its non-partisanship. In fact, a 1991 CBO study found that a single payer system in the US could cover all the uninsured at the (then) current level of spending or less because of reduction in administrative costs.

Many recently proposed health care plans, similar to the one Baucus says he is drafting, keep private-for-profit health insurance companies in the mix and are based on claiming huge savings from such things as the introduction of computerized record keeping. These so called savings are then touted as the way the proposed plan can be "paid for."

The CBO has issued a series of recent studies which have found that most savings claimed, in the effort to keep private-for-profit insurance companies in the mix, do not exist. Recent CBO studies of disease management, "medical homes," electronic medical records, comparative effectiveness research, a public plan that competes with the private insurers and others, do not save money as claimed. That is also what numerous peer-review academic research paper have found: Prenvetive care, chronic disease management, health IT - they are all good things (and done better under the less fragmented more planned single payer plan), but they do not save money in the short or medium term.

From the hearing

Sen. Max Baucus, Chairman: Thank you very much, Dr. Elmendorf. We have a huge problem, haven't we? This is the most difficult public policy undertaking I've experienced in my Senate life here. I've been here thirty years, and nothing is as difficult as this. Nothing is as important as this, and I cannot think of anything that depends so much on CBO, especially at a time we're in new territory. We're not in the old situation where Sen. Grassley once said whatever CBO says is God, you're God. My judgment, you're not God.

Douglas Elmendorf, CBO Director: Correct

Sen. Baucus: My judgment is that you got the whole new era - you might be Moses, but not God - but you got the whole new era... where as I said earlier it's not too much of an overstatement to say CBO can make or break health care reform, and I mean that because we got to go by your numbers. . .

Dr. Elmendorf: Senator, may I respectfully disagree that...

Sen. Baucus: I do believe that there are several different intellectually honest pathways to get from here to there. It's not just one automatic, and so it needs - you got to be ever more creative to find intellectually honest pathways to get the savings we have to have - practically and both politically - to get health care reform.

Dr. Elmendorf: Senator, I would like to just respectfully disagree with the make or break role that you have assigned to us. We will do our very best to provide you and all of the members of this committee and the rest of the members of the Congress with the technical information that you need, the best estimates that the knowledge of the world can provide about the effects of alternative policies, but, as you understand, the hard decisions will be yours.

Sen. Baucus: No, that's incorrect. The hard decisions will be all ours, both of us, you and me. You can't pass the buck. The hard decisions are here, and the hard decisions are yours and the hard decisions are all of us in this country in trying to make this work. Meeting's adjourned.

Dr. Elmendorf: Thank you, Senator


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