Nobody disputes that there is room for honest intellectual agreement; plenty of smart people dispute claims about savings that reform will generate. But it's an open question whether the CBO takes skepticism too far--and whether such a super-strict reading of the evidence really serves the public interest. As Obama himself frequently points out, exploding health care expenses are going to cripple the government and, eventually, the country. If the CBO's estimates or the decision to classify premium payments as government revenue end up paralyzing lawmakers, effectively snuffing out reform again, it's quite likely that the country's fiscal situation will be worse--not better--ten or 20 years hence.
Of course, lawmakers wouldn't need such favorable scoring if their proposals were a little bolder. If Obama and Congress could get more aggressive about steering reimbursements away from doctors and hospitals that provide poor care, the CBO would undoubtedly credit those moves as generating additional savings. And, if reformers were willing to find more tax revenue--by, say, declaring that premiums for the most generous health plans were no longer fully exempt from personal income taxes--they could raise the money they need. But those are tough political tasks. Providers of medical care don't like their incomes going down; taxpayers don't like their liabilities going up. In the end, Obama and Congress will have to live within certain constraints that the CBO sets--adjusting their proposals to coincide with the agency's predisposition or scaling back what they hope to do. The result might be an imperfect law, but, as the Clinton-care veterans will tell you, sometimes that's better than no law at all.
Taking on the special interests is the hardest part of health care reform.
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