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Sen. Mitch McConnell, R-Ky. (AP/Photo by Harry Hamburg)

Calculating costs

Healthcare | Beyond the Senate's delay tactics and emotional appeals is a need for better accounting

WASHINGTON-The ongoing Senate healthcare debate has featured a fair amount of drama-or at least what goes for drama in the stodgy Senate. For instance, take the nearly 200-page forced reading of a 700-plus-page amendment to create a single-payer healthcare system. The Republicans used Senate rules regarding the reading of amendments to stall for two hours and ultimately kill the single-payer-system dreams of a frustrated Sen. Bernie Sanders, I-Vt.

More dramatic have been the countless blown-up photos of uninsured Americans that serve as backdrops for pro-reformers' cries that the proposed $1 trillion bill now before the Senate provides the prescription needed to cure these ills. Few senators trumping the plan have failed to carry with them (or rather have an aide carry for them) to the Senate floor a decidedly non-glamour-shot photo of someone whose needs presumably can be wiped away by a greater governmental role in the nation's healthcare system.

But largely lost among these delay tactics and emotional appeals is a more mundane subject that holds the financial keys to the proposed overhaul: accounting.

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Sure, most American voters probably have unpleasant memories of their college accounting class. And nothing will make a debate viewer switch from C-SPAN to ESPN faster than a spreadsheet on an easel. But those who have stuck their noses into the 2,074-page healthcare bill have uncovered some math gimmicks that would even give your high school geometry teacher a few headaches.

Pro-healthcare reformers have spent the month ballyhooing the claim, backed by the nonpartisan Congressional Budget Office's analysis, that the bill's estimated $848 price tag over 10 years would actually cut the budget deficit by $130 billion.

But Robert A. Book, a senior health economist with the conservative Heritage Foundation, thinks that figure is misleading. He says the CBO's cost estimate spans from 2010 to 2019. But most of the bill's spending provisions do not take effect until as late 2014, while the government immediately will begin collecting most of the new taxes unleashed by the bill. So in effect, the CBO estimate considers a decade of taxation but only five or six years of actual new federal healthcare spending.

"It makes the bill look cheaper than it actually is," Book told me.

How much cheaper? Senate Republicans, uniformly opposed to Senate Majority Leader Harry Reid's bill, have argued that when looking at a full decade of new federal subsides and other programs created by the bill, the real 10-year cost would balloon to $2.5 trillion.

"This is the ultimate shell game that is Washington cynical politics," claimed Sen. Judd Gregg of New Hampshire, the senior Republican on the Senate Budget Committee.

Book believes there's another reason the new healthcare proposals won't kick in until 2013 or 2014 (despite the fact that reformer after reformer has argued that relief for the uninsured is needed now)-to get around the November 2012 presidential election.

"If this goes really badly it will be too late to be able to vote the president out of office," Book speculates.

Others see more accounting tricks in the furious push to get a bill passed before Christmas. Michael Cannon of the Cato Institute wrote, "Congressional Democrats have very carefully hidden more than half the cost of their healthcare bills."

His analysis reveals that the supporters of healthcare reform have learned their lesson from the failed attempt to overhaul the system in 1994 under the Clinton Administration. Then budget estimates for the bill's costs included the proposed mandates that individuals and employers purchase insurance.

Cannon estimated that such mandates accounted for as much as 60 percent of the total cost of Clinton's plan. Revealing the full cost, he writes, helped kill the Clinton bill.

Today, while individual and employer mandates are a part of both the House and Senate healthcare bills, none of the cost estimates of the current proposals have included the mandates.

"Keeping the cost of their private-sector mandates out of the federal budget has been Job One for Democratic health wonks," Cannon concluded.

Bill read-a-thons and compelling photos may be easier to watch on C-SPAN. But those trying to decode the Senate healthcare debate as it steamrolls to a potential final vote next week may be better served dusting off their old accounting textbooks and buying batteries, not just for Christmas gadgets, but also for that little-used calculator in the bottom desk drawer.

Edward Lee Pitts
Edward Lee Pitts

Lee teaches journalism at Dordt College in Sioux Center, Iowa, and is the associate dean of the World Journalism Institute.


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