Can the future of health care be scored?
Yesterday, the Congressional Budget Office released a preliminary analysis of the Affordable Health Choices Act, the draft legislation on health reform released by the Senate HELP committee. Although the cover letter to Senator Kennedy was couched in the language of caveats—there’s even a section called, “Important Caveats Regarding This Preliminary Analysis”—an article in the New York Times offered this observation from the the preliminary analysis, “As the president spoke at the annual conference of the American Medical Association in Chicago, it became clear that one of the major health plans on the table would cost at least $1 trillion over 10 years yet leave tens of millions of people uninsured.”
How, exactly, did this become clear? It’s true, these deficit and uninsured estimates stuck out as the headlines of the CBO’s preliminary analysis, but as the CBO also stated, these figures did not represent a complete cost estimate of the proposal, nor was it an estimate of all of the components of the proposal, just the ones related to health insurance, nor was the legislative proposal itself complete.
It seems like there really were no clear conclusions to be drawn from the CBO’s preliminary analysis, and anyone who draws a clear conclusion at this stage of the game might be suffering from a case of overstatement. The Congressional Budget Office is doing, I guess, what it is supposed to be doing: providing objective, nonpartisan analysis to help Congress understand the economic and budgetary impact of particular proposals. This seems, on its face, like a highly worthwhile endeavor, as long as people don’t take the analyses and go all nutty with the preliminary results. Meaning, the CBO itself offers a treatise on “The Uncertainty of Budget Projections,” (which, I confess, I did not understand at all, other than to grasp that there are uncertainties) and in addition, the CBO is what it is.
What do I mean by that last statement? Well, Congress obviously wants good scores from the CBO when issuing legislative proposals, especially when it comes to health reform proposals, “good” meaning that it’s not going to cost a whole mint of money without offering some savings in return. But at the same time, CBO operates within the necessary constraints of what has been, and what is, rather than what will be. Case in point: in December 2008, the CBO issued reports on health care and insurance options and what was frustrating (to me) about these reports is that the scoring of various health reform initiatives to improve quality of and access to care was based on past and current efforts—initiatives that represented basically laudable attempts in an overall health care environment that was broken and dysfunctional. So the reports did not end up illuminating the economic and budgetary impacts of comprehensive health reform initiatives, because the estimates were not based on what the future could become, they were based on what existed already.
Never having worked in the CBO or for a member of Congress, and having barely passed Econ 101 in college with a T.A. who barely spoke English, it is not for this poor naïve soul to lambast the Congressional Budget Office for behaving like, well, it’s supposed to behave. Because if the CBO did otherwise, as many wiser colleagues have pointed out to me, they might actually start to look like they were issuing legislation, rather than neutrally and conservatively scoring it (although how this helps shape the future, I am still at a loss to understand, and would love others to weigh in here). But I can certainly question how the media chooses to interpret--or in the case of the New York Times, over-interpret--and hope that others won't do the same, or even worse, treat these preliminary conclusions as fodder for a political fight.