Still reading that 1,990-page comprehensive plan.
While the 351 pages devoted to the Indian Health Care Improvement Act can be skipped, the preceding 427 pages that make up “Division C” of a “comprehensive” reform of the health-care system should at least be skimmed. This section, starting on page 1209, called “Public Health and Workforce Development,” contains a hodgepodge of new programs, and reauthorizations and amendments to existing programs, each of which has a fairly direct line to some interest group that wants something from the federal trough. Many are just one step up from an appropriations earmark as examples of pork. Mark Hemingway’s post from yesterday shares one example: veterinary students eligible for health professions loan and grant programs. This is another case of what’s surprising being not what’s new but what the federal government already does. The veterinary students have been eligible for “health professions” student loans for years.
Under most circumstances, many of these interest groups’ victories were only part of the fight. Yes, the Washington office staff could tout the victory won, but the promises would be worth nothing until an appropriations act turned the language in the authorization into cash. And at least the appropriations process was disciplined by the budget process that put an aggregate cap on discretionary spending. That allowed Congress to play a “good cop, bad cop” routine. The appropriation would be authorized, but no appropriation would ever be made because there wasn’t room in the zero-sum game of discretionary appropriations. But a footnote in the CBO analysis says that may not be true here. Table 3 of the CBO analysis has as its Footnote A, “Although that spending would not occur without the enactment of subsequent discretionary appropriations, the House Committee on the Budget has directed CBO to consider such spending as direct spending in this cost estimate.” CBO says that footnote is worth $33.4 billion over ten years. Pity the poor lobbyists for education, housing, and veterans health who can’t get such a good deal for their programs.
— Hanns Kuttner is a visiting fellow at Hudson Institute.