Healthcare Reform Follows Path of Broken Vows

Friday, 13 Nov 2009 02:47 PM

By Ernest Istook

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Why believe Congress’ new promises to control spending, when it reneges on its old promises and spends more than ever?

The “new” promise within healthcare reform bills is to reduce Medicare spending by hundreds of billions of dollars. Yet simultaneously, Congress is reversing 1997 legislation that claimed it would reduce Medicare spending.

The latest example of hypocrisy is known in Washington as the “doc fix,” (shorthand for fixing payment rates to doctors) and it’s scheduled for a House vote next week.

Doctors have a valid complaint that government underpayments make it unprofitable to see Medicare patients. But throwing more borrowed money at the problem makes things worse because it moves Medicare and the rest of the federal budget deeper into bankruptcy.

The cost estimate for the doc fix varies from $210 billion to $245 billion. But it’s actually far larger. The doc fix legislation “increases Medicare's unfunded obligation by $1.9 trillion using the 75-year horizon and by $4.1 trillion in the long term,” according to a study by Texas A&M scholars and a former Medicare trustee that the Heritage Foundation published.

This is on top of news that October’s federal deficit was $176 billion. That’s for a single month. Next year’s deficit is projected to surpass the $1.4 trillion record set this year.

A recent newspaper headline sums up Washington’s attitude: “After spending binge, White House says it will focus on deficits.”

“After.” Discipline is always put off until tomorrow.

The doc fix is accompanied by promises of “PAYGO” — pay-as-you-go rules to require new spending to be offset — and is full of the same loopholes Congress has exploited historically.

The doc fix itself was created by 1997 legislation that promised to curtail spending through future reductions in Medicare payment rates to doctors. Once the deadline arrived, Congress and the president pushed it back. It’s already been pushed back for seven years in a row. The House will vote next week on an extra 10-year pushback.

But there’s no new revenue source and no spending offsets for the extra costs of this. And Congress and President Obama have exempted this $250 billion from his promise not to add one dime to the deficit in healthcare legislation.

It’s a “King’s X” to their pledge. Time out. Fingers crossed.

Hope exists that fiscally responsible House members will reject the doc fix in a bipartisan way. One bright ray came when the Senate last month rejected the doc fix on a 47-53 procedural vote. This time around, the Senate has set a good example for the rest of Washington to follow.

Ernest Istook served in Congress for 14 years and now is a distinguished fellow at The Heritage Foundation.

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