One of the paradoxes of health reform is that you have to spend money to save it. The current system is killing our long-term fiscal outlook, and so it needs reform, but to achieve such reform you have to spend more now in order to save money later. The same logic applied, in a way, to the argument that the stimulus package was fiscally prudent--spend now so the economy doesn't go off a cliff. After the Senate Finance Committee bill passed today, one of the leading budget scold groups--and I use the term affectionately because I think they're more right than wrong--the Committee for a Responsible Federal Budget praised the overall direction of the bill but noted things that could make it even more fiscally prudent. Given that the bill is going to get married to more liberal versions in the House and Senate, I doubt that'll happen, but it's worth noting what they point to:
* Replacing the excise tax with a cap on employer-sponsored insurance tax exclusion at 75th percentile of premium costs - $160 billion
* Increasing cost-consciousness in Medicare through a unified deductible, uniform coinsurance, and catastrophic limit - $26 billion
* Restricting Medigap coverage of Medicare's cost-sharing - $41 billion
* Reducing Medicare payment rates in high-spending areas - $51 billion
* Enacting medical malpractice liability reform - $54 billion
Not gonna happen, but worth watching to see if fiscal hawks, Blue Dogs or anyone else can find wiggle room on these issues. By the way, do we take bets on whether Olympia Snowe votes for final passage of a bill? Kinda think so but wouldn't bet on my own bet.