The Health Care Marathon

Democrats are pleased with the CBO's preliminary score of the reconciliation package. Adding the cost of higher insurance subsidies, extra spending on Medicaid, and other outlays, then subtracting Medicare savings and new revenues yields a $138 billion reduction in the ten-year deficit, says the agency. That is better than many had expected.

I don't question the competence of the CBO's analysts, but I wouldn't bet my 401(k) on these numbers turning out to be even roughly correct. The uncertainties lie in both directions. The plan might save more money than the CBO says: it has scored the efficiency-promoting experiments conservatively. The bigger risk is that the provisions yielding the projected savings and tax increases will be reversed before they take effect. I would need to think about it, but I might be willing to bet my 401(k) on that.

I continue to be puzzled by the agonies House Democrats are going through over whether they should vote, or be seen to vote, for the Senate bill on the way to the full reconciliation package. To my innocent eye, the differences between the Senate bill and the House bill seem relatively small. When I last made that observation I got a lot of complaints from people telling me that the Senate bill is much more permissive on abortion. As Ruth Marcus explains, this is not so.

Compare the language of the Senate and House measures and try to find the supposed differences. Both measures would prevent insurers from being required to cover abortions. Both measures would continue the existing prohibition on federal funds being used to pay for abortions...

The House bill requires those who want to obtain abortion coverage to buy a separate policy, using no federal funds. The Senate bill requires that plans covering abortions collect a separate premium check for this coverage. Separate policy vs. separate premium: This is enough of a difference to affect the fate of the legislation?

I was wrong in my previous post on health care to say that the constitutionality of "deem and pass" is not in question. That was stupid of me. I should have known that there are remarkably few things whose constitutionality is not in question, and "deem and pass" is not one of them. I can't imagine the Supreme Court overturning the strategy, but legal challenges appear to be a distinct possibility.

Fred Barnes argues that, legal challenges aside, the health-care wars are only just beginning if the Democrats succeed this weekend. I'm sure he is right about that. But the same will be true if the Democrats fail. In either case, the issue is not going away.

Barnes is correct to say that Britain's National Health Service is a perennial subject of complaint and contention. But shutting it down and replacing it with a US-style system would arouse near-universal outrage. The failings of the NHS are real. I can tell you from personal experience it has many. But US commentators should ask themselves why no political party--not even Margaret Thatcher's conservatives-could contemplate privatizing it. If I were offered the choice between the NHS and the US system I would choose the NHS. Standards are lower (compared with those for the insured in the US) and there are waiting lists; but access is guaranteed and serious illness does not mean bankruptcy. I think I might choose the NHS for relief from the intolerable burden of insurance company paperwork alone. Spending what the US does on health care, higher standards and guaranteed access should both be attainable. Which is why I am for the Democrats' plan.

If you haven't already spotted it, The Hill is maintaining an up to date whip count for the weekend's vote. Pelosi's reported optimism is hard to square with the numbers at this point, but doubtless she knows more about her members' intentions than they are telling the press.