About That CMS Report

The House health care bill received a not so fantastic report from the Center on Medicare and Medicaid Services, issued at the request of the GOP membership of the House Ways and Means Committee, in terms of its efforts at cost-containment. One can quibble with the details here, but the basic conclusion is correct—the House bill is admirable in terms of expanding access to health care and improving affordability for working- and middle-class families, but its cost-containment measures involve more wishful thinking than one would hope for.

The question is what to make of this. The opinion of the House Republicans, Fred Hiatt, and Tyler Cowen seems to be that we should vote the bill down, thus depriving the currently un- or under-insured the benefits of the House bill while also not accomplishing anything on the cost-control front. A better approach, suggested by Igor Volsky, is that those interested in seeing more cost-control push for the inclusion of more robust cost-control measures such as the insurance excise tax and super-IMAC provisions that are in the Senate health care bill. Pushing for a more robust version of the public option, such as liberals initially wanted to see in the House bill, would also help.

In practical political terms, the path that makes cost-control relatively likely is a path on which Republican members of congress offer to support health reform if the final package contains such measures. Similarly, right-of-center intellectuals and commentators concerned about cost control should be urging right-of-center legislators to try to put such a deal on the table. The current posture, in which Republican members make it clear that they won’t support a universal health care bill irrespective of the details, does less to reduce the odds of a bill passing than it does to reduce the quality of the legislation that emerges. We saw this dynamic play out with the Waxman-Markey bill already and it doesn’t serve the country’s interest.