When health-care reform started, Democrats made an admirable effort to end the shell game and just fix the system. But doing so cost almost $300 billion, and Republicans, who caused this mess in the first place, attacked the Democrats’ fix as if it was part of their health-care reform plan rather than part of the Balanced Budget Act that Republicans passed in 1997. So Democrats abandoned the effort and left the fix out of health-care reform.
This is a slightly problematic reading of what happened. An Economics 21 editorial published in February offers a different take:
The Administration and Congressional Democrats first got into trouble on this issue when they tried to pull a fast one, inserting higher physician payments into the early drafts of health care reform bills without offsetting the costs. The Congressional Budget Office (CBO) blew the whistle on this maneuver, finding that it would result in health care “reform” adding enormously to the federal government’s already-unsustainable deficits.
Proponents then tried what can only be described as a cynical gimmick: they simply split the bills into two parts: a “docfix” bill that would add to the deficit, and a separate health care bill that would be advertised as lowering the deficit. Taken together, it was always the case that the bills would worsen the fiscal outlook. But by pointing only to the “deficit-reducing” bill and ignoring the companion “docfix” bill moving through the Congress, disingenuous claims that health care reform would reduce the deficit continued to be made on both ends of Pennsylvania Avenue.
The House of Representatives played its dutiful role in this charade, separately passing both the health care legislation and the deficit-worsening docfix bill. The Senate, however, balked. When Senate Majority Leader Harry Reid attempted the same maneuver there, several Democrats as well as Republicans refused to play along with the game. Reid’s “docfix” bill – which would have added $247 billion to the debt over ten years – failed on a 47-53 cloture vote last October. No doubt the Senate was influenced by rising public concern about skyrocketing deficits and irresponsible budgeting. But the Senate vote didn’t end the “docfix” issue; it merely left it unresolved. Just how unresolved was revealed again this week with the release of the Administration’s budget.
This gives us a very different impression of how the debate unfolded.
Moreover, my sense is that the Balanced Budget Act of 1997 was not passed on a party line vote. The following is from Govtrack:
Jul 30, 1997: After passing both the Senate and House, a conference committee is created to work out differences between the Senate and House versions of the bill. A conference report resolving those differences passed in the House of Representatives, paving the way for enactment of the bill, by roll call vote. The totals were 346 Ayes, 85 Nays, 4 Present/Not Voting.
Suffice it to say, Republicans did not hold 346 seats in the House in 1996. PPACA is far more accurately described as partisan legislation than BBA.
I absolutely agree with Ezra on at least one point — we really do have to fix SGR.
Monday, June 21, 2010