Critical Condition

Murk-ulski? Mik-owski?

The U.S. Senate has taken its first votes in the health-care debate. The best early write-up of the Murkowski/Mikulski amendments on women’s health-screening votes is by David Herszenhorn and Robert Pear. The Senate agreed not to let the Preventive Services Task Force change a specific practice, namely mammograms after age 40, but did not agree in general to prevent the task force from limiting other practices in the future. This is hot-button politics masquerading as medicine. Rationing decisions that get raised to national attention, such as the mammogram decision, will be voided by Congress if there is enough of an outcry, but the task force will presumably continue to suggest limits on lesser known, less popular practices. The result will be an increase in efforts by advocacy groups to protect their most favored procedures and screenings, as they know Congress will overturn decisions if their is enough political pressure for them to do so.

This is one reason that even if the current efforts become law, the whole issue would have to be revisited in relatively short order. As I argue in Politico today, another reason we won’t be done with this issue anytime soon is cost. The Senate bill frontloads the taxes and backloads the benefits in order to get the bill scored as revenue neutral in the first ten years. In addition, CBO is rightly skeptical of Congress’s willingness to follow through on the doctor-reimbursement cuts that represent a big chunk of the bill’s so-called savings. As a result, the costs of the bill will likely grow so quickly that Congress will have to reopen the issue to limit benefits, increase taxes, or both.

Tevi Troy is a presidential historian and former White House aide. His latest book is Fight House: Rivalries in the White House from Truman to Trump.