Pearlstein: Damn the CBO, Full Speed Ahead on Health Reform

The Washington Post’s Steven Pearlstein is feeling the fierce urgency of now and wrote a pretty great column about why we shouldn’t let green eyeshades concerns kill comprehensive health care reform:

There is, for example, general agreement that it will cost $100 billion to $150 billion a year to provide the subsidies necessary to allow all Americans to afford a basic health plan. But the Congressional Budget Office, the official scorekeeper on these matters, has been reluctant to certify the major cost savings that might come from various proposals to restructure the health delivery system, or reform the health insurance market to make it more competitive, or change the way doctors and hospitals are compensated so they have the incentive to use only the most cost-effective treatments.

It is, of course, the CBO’s job to be skeptical, particularly after a number of past experiments in this area have yielded disappointing results. But it is also true that because nothing of this scale and complexity has been tried before, projecting the fiscal impact is next to impossible. This budgetary standoff will leave Congress with no choice but to try to finance its health-reform efforts by raising taxes or limiting payments to doctors and hospitals, possibly jeopardizing the entire project.

We can certainly applaud policymakers for their reluctance to enact another expensive and popular entitlement program without finding the money to pay for it. But it is folly for them to put themselves in a political and procedural straitjacket. In all of history, no revolution was ever made by budget analysts. Health reform requires leaders with the foresight and confidence to take a leap into the unknown.

I agree with this. I’m torn between wishing the CBO would just decide to get more aggressive with its scoring, and wishing that the congress would just decide to get more aggressive with its revenue-enhancements. But the fundamental point is that politicians need to be aggressive in terms of reforming the health care system and putting a new framework in place. According to the political rules of the game, the estimated costs and revenues in 2017 are very important. But the fact of the matter is that nobody really knows what’s going to happen in 2017. What we do know is that if we just keep drifting along until 2017, things will get worse and worse.