The Corner

Addition and Subtraction

The revisionist history on display in this post is refreshingly bold. Of conservatives’ “obsession with the doc fix,” Ezra Klein writes:

The easiest way to show that a bill increases the deficit is to show that revenues don’t equal or exceed spending. That was true for, say, the Iraq War and the Medicare Prescription Drug Benefit and the Bush tax cuts. It is not true for the Affordable Care Act.

So Republicans have had to come up with a way to change the arithmetic. That gives them two options: Either delete something that’s in the bill on the revenues side or add something that’s not in the bill onto the spending side.

According to Klein, Republicans changed the arithmetic by “adding” the doc fix to the debate. What really happened? Last July, House Democrats submitted the first draft of Obamacare to the Congressional Budget Office, hoping to get a budget-neutral score. They failed. The CBO report stated that “enacting H.R. 3200 would result in a net increase in the federal budget deficit of $239 billion over the 2010-2019 period.” The biggest source of the increase, according to the report, was the provision that would “change payment rates for physicians’ services to replace the 21 percent reduction in payment rates scheduled for January 2010″ — a.k.a. the doc fix. The CBO reported that the fix “would cost $228 billion over the 2010-2019 period.” Hmm… almost exactly the amount the Democrats needed to trim from the bill to get a budget-neutral score.

One problem: Democrats had secured a tenuous endorsement from the American Medical Association, and they wanted to keep it. The doc fix was crucial to keeping the AMA’s support. So what did they do? They removed the doc fix (“delete something that’s in the bill”) and tried to pass it separately in October, before either chamber acted on Obamacare. “Reid had offered the doctors group a deal to pass the ‘doctors’ fix’ in return for support from the doctors on President Barack Obama’s broader healthcare initiative,” reported The Hill newspaper. But Republicans and moderate Democrats balked, because the ploy — to shave dollars from the Affordable Care Act while keeping a provision that was crucial to its political viability — was so embarrassingly transparent. 

Now Klein might say this smacks of arbitrariness: If Democrats hadn’t included the doc fix in an early version of the bill, we might not be having this conversation. But the “doc-fix deletion” was hardly the only example of Democrats gaming the CBO: The whole process was characterized by this kind of “I’m thinking of a number” arbitrariness. Relevant provisions were subtracted or delayed and irrelevant ones (student loans, anyone?) were added arbitrarily to improve the bill’s score. The parlor game distracted attention from the fact that even if Obamacare delivered these modest savings, it would still spend a lot of money, raise taxes, and make it more difficult for future policymakers to find offsets when they needed to pay for things like, oh, I don’t know, the doc fix.

The debate over the doc fix is a debate about this larger context. We can’t pay for the entitlements we have, yet the Democrats just created another one.


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