This morning I heard the Wall Street Journal's Peggy Noonan yammering on Morning Joe about how health care reform was a "catastrophe" because it ignored the public's concern over deficits. Not to put too fine a point on it, but Noonan doesn't know what she's talking about. My guess is that she's willfully ignorant because spreading falsehoods is essential to her script and her political CYA as a Reaganite. This is the woman who wrote Reagan's pretty words about big government and the national debt, while Reagan's tax-cutting policies created increases in deficit spending that were unprecedented.
I would be interested in seeing evidence of "deficit hawk" Noonan's previous critiques of the Bush tax cuts that further drove the government into a deficit ditch. My guess is that we won't see such because they never existed.
The CBO has scored the health care reform bill as the biggest deficit-reducing legislation in the last quarter century - since Bill Clinton attempted to repair the damage done by Reagan to federal coffers. Never mind - Peggy's a GOP shill and follows the "message" no matter how disingenuous or deceitful.
But another view made its way into the Journal this week that's worth paying attention to - David Cutler, a Harvard-based health care economist and advisor to the Obama White House got his op-ed published that deals directly with the cost-benefits of health care reform. He systematically analyzes it's strengths and weaknesses. Here's most of Cutler's conclusions;
Over the past year of debate, 10 broad ideas have been offered for bending the health-care cost curve. The Democrats' proposed legislation incorporates virtually every one of them. Here they are:
• Form insurance exchanges. These would help curb underwriting and inefficient marketing practices that raise costs in the small-group and individual insurance markets. This is addressed in all the House and Senate bills, and the president's proposal. Grade: Full credit.
• Reduce excessive prices, including those of supplemental plans enrolling Medicare beneficiaries. The president's proposal reduces these Medicare Advantage overpayments and others to different providers, even in the face of Republican claims that reducing such overpayments is tantamount to rationing care for seniors. Grade: Full credit.
• Moving to value-based payment in Medicare. Both Democrats and Republicans have called for moving from a system where volume drives reimbursement to one where value drives reimbursement. The president's proposal includes virtually every idea offered for doing this. Grade: Full credit.
• Tax generous insurance plans. Health-insurance benefits are excluded from income taxation, providing incentives for excessively generous insurance. Many economists have proposed capping the tax exclusion to reduce these incentives. The president's proposal taxes some of the most generous policies, though it has deferred the date by which these taxes take effect. Grade: Partial credit.
• Empower an independent Medicare advisory board. Interest-group politics intrudes too deeply within the mechanics of Medicare policy, raising program costs and hindering efforts to improve care. Despite powerful opposition, the president proposes this independent board and a process for fast-tracking such recommendations through Congress. Grade: Full credit.
• Combat Medicare fraud and abuse. The administration has started an active task force to combat these problems. Other ideas to reduce fraud and abuse were presented at the recent health-care summit, and were incorporated in the president's proposal. Grade: Full credit.
• Malpractice reform. Defensive medicine is a small but important driver of medical spending. The reform proposal makes some headway, encouraging states to experiment with alternative mechanisms to reduce malpractice burdens. More could be done—for example, specialized malpractice courts and a safe harbor for physicians practicing evidence-based medicine—but the president's proposal makes a start. Grade: Partial credit.
• Invest in information technology. Many studies suggest savings in the tens of billions of dollars from IT investment. The stimulus bill passed a year ago contains funds to wire the medical system over the next few years, and the administration is supplementing this with significant funds to analyze the comparative effectiveness of different treatments—even in the face of "death panel" claims. Grade: Full credit.
• Prevention. The president's proposal includes significant public-health investments, provides new incentives for physicians to focus on preventive and chronic care, and opens Medicare to finding new ways of supporting prevention. The only area of weakness is the lack of a junk food tax or tax on sugar sweetened beverages. Grade: Partial credit.
• Create a public option. A public insurance option would provide competition for insurers in areas that are nearly a monopoly and provide a path for reforms in Medicare to expand readily in the under-65 population. The public option was eliminated because of Republican opposition, however. Grade: No credit.
So reform gets full credit on six of the 10 ideas, partial credit on three others, and no credit on one. The area of no credit (a public option) is because Republicans opposed the idea. One area receives only partial credit because of Democratic opposition (malpractice reform) and two other areas reflect general hesitancy to increase taxes (taxing Cadillac plans and taxing drivers of obesity).
Is the bill optimal ? No. Is it a major step in the right direction, expanding coverage consistent with the need not to finance a large new federal program with deficit spending (like the Bush prescription drug bill, supported by most of the Republicans currently screaming about "deficits") ? Clearly, based on the best available facts and analysis.
Anyone honestly concerned about federal deficits and the drag on the economy of health care costs should support this bill. People decrying federal spending and deficits who oppose the bill are putting their worst fears over the best evidence or - and I think this is more to the point in the case of partisan opponents - deliberately lying about the bill.