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The Boring Bureaucrats of the CBO Score

The Congressional Budget Office is back in the news, what with all this fuss about repealing Obamacare and replacing it something or another that in any case isn’t to be called Trumpcare, and we’re heartened to see their reassuring initials again. Back when political news was mostly a boring affair about arcane accounting questions the boring bureaucrats of the CBO were always in the lead or at least third paragraph of every story, but that was before the political news became more entertainingly about the latest “tweets” and the accusations of treason being flung from both sides, so lately we find ourselves missing the old days.
That good ol’ CBO finds itself back in the news because of its long-awaited “scoring” of the first of three promised phases of repeal of Obamacare and replacement with something that nobody is calling Trumpcare. The report contains plenty of argumentative ammunition for the Democrats who are unanimously opposed to the plan, possibly enough to scare some of the Republicans with whetted thumbs against the political winds, and a few big numbers that speak well for the first phase of the scheme but might embolden its conservative critics. All in all it was the desultory conclusion that you’d expect from a numbers-crunching bunch of boring bureaucrats, which is what the CBO is paid to be, and within a certain margin of error involved in all human undertakings we’re inclined to accept their findings.
One finding is that 24 million fewer Americans will have health insurance over the next decade if the current proposals of repeal and replace are enacted, which is a number hard for the most pro-reform media to spin, and which the anti-reform media gleefully headlined. The pro-reform forces therefore questioned the supposedly boring objectivity of the bureaucrats at the CBO, rightly noting its past errors in overstating the benefits and understating the costs of Obamacare, but they’ve conveniently forgotten how that happened. We were among the anti-Obamacare voices who noted that the CBO was diligently “scoring” those costs and benefits according to the pie-in-the-sky assumptions and spreadsheet legerdemain that the Democratic administration and Democratic majorities in Congress had described, and that the CBO had made that disclaimer quite clear, and when you take into account that the CBO’s forecasts couldn’t have taken into account subsequent Supreme Court decisions and other events they did about as well as anybody. If the current Republican administration and Republican administrations in Congress didn’t offer such helpful guidelines we can hardly blame those boring bureaucrats as the CBO.
Even without any helpful guidance from the Republicans the CBO has concluded that the first part of more or less Grand Old Party’s three-phase plan would lower federal deficits by a not insignificant $337 billion, given the nation’s poor fiscal health, and would eventually reduce the average American’s health insurance premiums by 10 percent, which by the now the average American would not consider an insignificant sum. The Republicans should be able make some political hay out of those numbers, but at the moment they’re busy discrediting everything the CBO says, and the eventual part will only play out long after the next election cycle and just before the president’s reelection race. The CBO’s past miscalculations were based on the garbage-in-garbage-out assumption of the Democrats who front-loaded their carefully planned Obamacare with early benefits and defrayed costs, while the CBO’s current calculations reflect the Republicans’ longstanding preference for paying up front, and although that makes for good policy we can’t fault the CBO if it makes for lousy politics. If the American public isn’t taking a longer range view of the situation, neither can we fault the CBO for that.
So far as we can tell from the CBO reports and everything else we read and hear and see this Obamacare thing has made things better for some people and worse for others and on the whole worse all around, and we’re quite sure this three-phased real and replacement with something that won’t be called Trumpcare might prove better but surely won’t be perfect. We’re holding out hope that nuns won’t be forced to pay for contraceptive coverage and monogamous married couples won’t have to fork out for sexually transmitted disease plans and teetotaling types aren’t hit up for alcoholism treatment, and that the the youngsters who only need catastrophic care can pay on the cheap, and that the daredevils can continue to defy the actuarial tables, but by now we have to admit that the benefits won’t come without costs, that those costs are actually figured in the long term that people rarely consider, and even those boring bureaucrats at the CBO can’t make any reliable predictions.
We always liked those old-fashined Republicans who used to acknowledge such uncertainties, but these days the party is represented by President Donald Trump and his campaign promises that everyone was going to be covered and the government would pay for it and premiums would go down and care would go up and everything would be great. He was never clear about the details, and being a big picture guy he seems to have left those details up to those Republican establishment guys he ran against, and they seem to have some old-fashioned ideas about paying up front and letting some number of Americans that might approach 24 million go without health insurance, and although there are philosophical arguments to made for that which the CBO can’t score he doesn’t seem able to make it, and this repeal and replace thing seems to be the very first time in his life that he doesn’t want his name on something.
As bad as Obamacare was we’ll still expect something better, but not matter what happens we won’t blame those boring boring bureaucrats at the CBO.

— Bud Norman

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What’s the Symbol for Hate?

Every now and then during our drives about town we will spot a bumper sticker on another vehicle exclaiming that the motorist loves Obamacare. A heart-shaped symbol substitutes for the word “love,” as if scanning the four letters would take too much time out of our busy days, and of course there’s no room at all for an explanation of this uncommon affection.
Which is a shame, because we’d love to hear these proudly Obamacare-loving drivers state their reasons. It was easy enough to understand the enthusiasm back when the so-called Affordable Health Care Act was being pitched to an unwary public, and it was going to provide coverage to every single citizen and perhaps even a few non-citizens while allowing everyone who was satisfied with their existing plans to keep them, somehow help the employers who would suddenly be stuck with reams of new regulations, and cost the public treasury a trifling $980 billion, and lower everyone’s premiums to boot. Only the hard-hearted skeptics didn’t love that, but now that they’ve been proved right in every regard those bumper stickers are hard to comprehend.
By now those drivers should know that at least four million of the uninsured will choose to pay a fine cheaper than insurance and remain uninsured, at least seven million people with insurance will be forced off their plans whether they like them or not, employers are hoping to reduce their newly imposed costs by limiting workers’ hours, the Congressional Budget Office’s estimated tab after the budget gimmicks expired has now swelled to $1.85 trillion, and in the latest bit of vindication for the skeptics a Society of Actuaries report says the price of an insurance premium will continue to rise for most Americans. Health and Human Services Secretary Kathleen Sebelius admits that at least part of the rise is directly attributable to Obamacare, telling a group of reporters on Tuesday that “These folks will be moving into a really fully insured product for the first time, and so there may be a higher cost associated with getting into that market.”
The secretary was quick to add that some people will see their insurance costs go down and that subsidies will be available for many lower-income Americans to help them with the cost of their newly-mandated coverage, and others with a heart-on for Obamacare will no doubt find other silver linings. There seems to be an awfully dark cloud within those silver linings, though, particularly for the now-quite-lower-income Americans who will be paying both higher premiums and higher taxes as a result of the subsidies, and Obamacare’s more realistic fans are already talking about the latest round of revisions and refinements. We anticipate that they’ll find all the problems are caused by the pesky remains of a free market insurance system and that even more government control is required, and if the problems persist they’ll prescribe more of the same.
Some conservatives have argued all along that Obamacare was meant to fail to such an extent that the public would at last demand a full-fledged single payer system such as can be found in the more fashionably socialized countries. They’ve been dismissed as paranoid right wing crackpots, of course, but we knew quite a few left-wingers who giddily espouse the very same theory as the reason for their support of the bill. Those who love Obamacare for its faults tell us that fully government-run health will be wonderful, but they’re hard-pressed to explain why something that’s so obviously a good idea can’t be sold to the public without mucking things up first, and they don’t seem to have planned for the possibility that a public fed up with higher premiums and worse care might turn to Republican congressional candidates disinclined to go the Swedish route, but they’re the only ones who seem pleased with the way things are going.

— Bud Norman