The health-care plan unveiled yesterday by Senate Majority Leader Harry Reid has some in the mainstream media gushing because, on paper at least, the Congressional Budget Office (CBO) says it will reduce the federal budget deficit by about $130 billion over ten years, and more in the second decade.
But the supposed fiscal prudence of the Reid plan is a complete mirage, for a number of reasons.
For starters, the Reid plan assumes that Medicare physician fees will get cut by about 20 percent beginning in 2011 and then remain very restrained indefinitely. Virtually no one in Congress believes that will happen, nor do they want it to. Indeed, just a couple of weeks ago, Senator Reid himself tried to overturn the planned cuts in physician fees, at a cost of nearly $250 billion over a decade. It does not matter to taxpayers if Senate Democrats try to pass their health-care agenda in one or two bills. The total cost will be the same. With the so-called “doc fix” included in the tally, the Reid plan would increase the federal budget deficit by about $100 billion over ten years, not reduce it.
Then there are the tax increases. CBO gives Senator Reid credit for cutting the budget deficit in a second decade, but that’s not because the plan would do anything to slow the pace of rising health-care costs. It wouldn’t do much of anything in that regard. What it would do is impose massive tax increases, in part by resorting to the same kind of discredited “bracket creep” so despised by the public in the 1970s. At that time, the thresholds separating the various income-tax brackets were not indexed for inflation, which meant that every year many people paid taxes at a higher rate simply because inflation had boosted their wages. Of course, many in Congress liked it that way because it meant a tax increase without the nuisance of a politically unpopular vote. Senator Reid and his Democratic colleagues are trying to pull off the same trick now. They are proposing two tax increases which would hit America’s middle class increasingly hard over time because the dollar thresholds used to assess the tax are not indexed to full inflation. The first, the 40 percent excise tax on high-cost insurance plans, would apply initially only to family policies exceeding $23,500 in annual premiums and individual plans with premiums exceeding $8,500. Those thresholds would increase by general inflation plus one percentage point each year, but that would be still below the rate of expected medical inflation. Consequently, more and more middle-class families would find themselves bumping into the premium thresholds as time passed.
Similarly, Senator Reid wants to raise the Medicare payroll tax, now 2.9 percent, on workers with incomes exceeding $200,000 per year, to 3.4 percent. But, again, that income threshold would not be indexed for inflation, which means many millions of families would be paying it in ten years who wouldn’t be paying it initially.
The end result would be a massive overall tax increase. In the first ten years, CBO says it would total nearly $500 billion, which is bad enough. But in the second decade, the tax increase would balloon to about $1.7 trillion, in large part because of the hidden tax hikes associated with bracket creep. Over 20 years, Senate Democrats are thus planning to raise taxes on the American people by about $2.2 trillion.
Even so, this massive tax hike still would not fully cover all of the spending in the Reid plan. According to CBO, the cost of the so-called “coverage provisions” would be about $850 billion over a decade, but that’s only because they wouldn’t kick in until 2014. CBO expects the annual cost of these provisions to grow about 8 percent every year. In the second ten years, the cost would therefore soar to $3.1 trillion.
Senator Reid’s bill also includes numerous other spending provisions which the press dutifully excludes from the reported total. These are mainly relatively small demonstration programs or tweaks to existing programs buried in Medicare and Medicaid. But because there are so many of them, their cost adds up. Overall, CBO expects these non-coverage spending items to total about $90 billion over the period 2010 to 2019, which pushes the total cost of the Reid plan to $940 billion over ten years — above the $900 billion limit the president said he would impose. Throw in the “doc fix,” and Senate Democrats are planning to spend nearly $1.2 trillion on their health-care agenda.
Finally, there are the Medicare cuts. Despite all of the talk of “delivery system reform,” the Senate Democratic plan would not transform American medicine to make it more efficient. No, they would simply cut payment rates for providers of services. On paper, the cuts are massive. CBO says they would total nearly $450 billion in Medicare over the first ten years, but then grow to about $1.9 trillion in the next decade. Just like physician fees, virtually no one believes Congress will sustain arbitrary payment rate cuts of this magnitude. And without them, the Reid plan is a clear budget buster.
So, here’s the bottom line. On paper, the Reid plan plus the “doc fix” would increase total federal spending by about $4.9 trillion over 20 years. Senate Democrats would resort to bracket creep and other tax hikes to raise $2.2 trillion over the same period. The balance would be made up with spending reductions, mainly in Medicare, that no one believes can be sustained, and in any event do not constitute “health reform.” In other words, it’s a tax-and-spend bill of the highest order. And only the spending is certain to happen.