The biggest problems with this imperfect bill arise from cost. It does too little to tame health inflation, as Douglas Elmendorf, head of the CBO, hinted this week. And the bill is likely to cost far more than currently advertised, because of two wheezes. One is a lethargic implementation plan, which means that the full annual cost will not kick in for a few years yet (thus making the CBO’s mandatory ten-year cost estimate misleadingly low). The second is the assumption of heroic cost savings from Medicare and big cuts in payments. Stuart Butler of the Heritage Foundation, a conservative think-tank, scoffs that “this legislation is an example of the triumph of budgeting hope over experience.”
Stuart is a very straight shooter on this. He represents the position of a conservative policy wonk in favor of real structural reform. Hence his total isolation right now.