Paul Krugman and Jonathan Cohn wax enthusiastic about the news that representatives for the nation’s major health care provider organizations—doctors, hospitals, drugmakers, device makers, and insurers—will come to the White House and announce that they believe it’s possible to achieve $2 trillion in cost savings over ten years without compromising patient care. Ezra Klein is more skeptical, worrying that these groups haven’t really made any firm commitments to anything in particular.
But the real import of today’s event isn’t in its signal for what industry insiders may do in the future, it’s for the Congressional Budget Office. The main impediment to a health care deal, at this point, is cost. The up-front costs are large. To cover these costs, the Obama administration proposed several exceedingly reasonable tax changes, focused on curbing deductions for high-income taxpayer. This is the most economically efficient possible way of raising revenue, so naturally congressional Democrats rejected it out of hand.
That means that to make the costs work, it’s going to be necessary to rely on reform’s inherent potential to wring some of the massive waste out of the system. The problem here is that the CBO has been reluctant to “score” such savings in its official account of the bill. As Igor Volsky emphasizes, this industry statement is an important challenge to that CBO reluctance:
Early reports indicate that the signers — the Advanced Medical Technology Association (AdvaMed), America’s Health Insurance Plans (AHIP), the American Hospital Association (AHA), the American Medical Association (AMA) and Pharmaceutical Manufacturers of America (PhRMA), among others — hope to contain costs by implementing “aggressive efforts to prevent obesity, coordinate care, manage chronic illnesses and curtail unnecessary tests and procedures; by standardizing insurance claim forms; and by increasing the use of information technology, like electronic medical records.”
The industry is suggesting that these cost containment measures — which don’t score too well with the Congressional Budget Office — would in fact yield cost savings and help finance health reform. The letter blunts conservative critics who argue that health reform is unsustainable or too expensive, and it also takes on the CBO, whose models are likely under-scoring the savings from reforms.
Whatever kind of backstabbing these industry groups may or may not do in the future, they won’t be able to take back the fact that once upon a time they stood beside the White House in agreeing that it’s possible to achieve massive cost-savings without compromising patient care. That argument may well prove hugely important, politically, to getting a package through congress.