Jonathan Chait is upset that conservatives are clinging to a “myth” about the role that the “doc fix” played in the broader debate over Obamacare. Chait is right that some conservatives have incorrectly claimed that Democrats partially offset the spending in Obamacare by pretending that they would not enact the doc fix, even though everyone knew that they would do it eventually. But that doesn’t mean that conservatives don’t have legitimate gripes with the way the Democrats used a generous version of the doc fix to build support for Obamacare and then, when an early draft came in over-budget, pulled it from the bill, but promised doctors they would pass it later. I wrote a post shortly after Obamacare passed that attempted to explain 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.

In fact, this is precisely what is happening now. Senate Democrats would love to make good on their promise to the AMA to pass the doc fix in exchange for the AMA’s support for Obamacare, but they can’t find the offsets, and thus don’t have the votes.