Health bill kills the nation on the deficit

By William Mckenzie

America’s public debt is a monster, trillions upon trillions of dollars piled atop each other. We nod solemnly when we hear about it, but the truth is few of us know what to do about a number at $11.9 trillion and rising. We have a hard enough time balancing our checkbooks.

This health care debate, however, provides us a chance to start battling the beast. And our part is simple: Tell your legislators not to support any bill that adds to the national debt, the accumulation of annual spending deficits.

Sure, most lawmakers, including President Barack Obama, say they don’t want to add to the debt. But lost in the reporting about insuring more Americans and controlling health costs is that the bills being considered, including the preferable Senate Finance Committee version authored by Democratic Sen. Max Baucus, could easily blow open the deficit.

That’s because they’re being paid for largely on promises of future savings. You must look deep into the details to find that that’s what’s going on.

Take the Baucus bill, which the Congressional Budget Office originally projected would not add to the deficit. A big chunk of the revenues on which it banks come from future savings in Medicare and other health costs.

That should make us nervous. Some savings will happen, yes, but there is no guarantee most will.

Consider the past. Going back to the Clinton administration, Congress has tried to cut how much doctors get paid for treating Medicare patients. For a while, lawmakers kept those Medicare cuts mostly intact. But doctors started complaining; soon, Congress restored some of those payments to keep doctors happy.

In fact, the current House bill makes a big point of rescinding more recent cuts in Medicare payments to doctors. It restores something like $230 billion — which is how the House got the American Medical Association to go along.

Getting savings on paper is the easy part, as Bob Bixby of the deficit-fighting Concord Coalition lamented over the phone last week. It’s much harder to see them come to fruition.

And just to be clear, I’m not arguing against reforming our dysfunctional health care system. But more “reform” than we can reliably afford replaces one problem with a larger one. And that’s the course we’re on.

The House plan also relies on future savings: About half of its initiative would be financed through trimming Medicare.

Deficit hole

What’s really scary is that even if all the House’s savings assumptions come true, the thing still blows a hole in the deficit. The CBO estimates Congress will need $200 billion or more to close that gap.

And guess what. That hole is likely to grow.

The House wants a surtax on wealthier Americans, hoping to raise $544 billion over 10 years. Two problems: Many people already predict the Senate will kill the surtax; and even if, by miracle, it survives, the tax is not slated to rise in a way that keeps pace with health care’s annual inflation rate.

Anyway you look at it, the House plan is underfunded.

The Senate’s main tax idea could work better. Mark McClellan of the Brookings Institution says its tax on expensive health plans will grow with health costs.

Great, but remember the Senate would finance much of its bill through hoped-for savings.

Like that $11.9 trillion deficit, it’s hard to grasp all these details, but this is a debate where details matter.

So far, there’s no reason to think they won’t explode the deficit. That would be a serious irresponsibility, but if we’re intent on having a health care bill, let’s at least be honest that it’s not likely to add up.

X William McKenzie is an editorial columnist for The Dallas Morning News. Distributed by McClatchy-Tribune.