Oh what a tangled web we weave, when first we practice to deceive," wrote Sir Walter
Scott in his 1808 poem, "Marmion."
I doubt Senate Majority Leader Harry Reid, D-Nev., has read "Marmion." But he now
has a pretty good idea of what Sir Walter Scott meant.
Democrats have been tying themselves into knots in their efforts to conceal from the
public the true cost of Obamacare. Last Wednesday, their schemes came crashing down
around Harry Reid's ears.
Democrats were heartened Oct. 7 when the Congressional Budget Office said the
version of Obamacare drafted by Sen. Max Baucus, D-Mont., chairman of the Senate
Finance Committee, would cost "only" $829 billion over 10 years. The CBO had scored
versions proposed by the Health, Education, Labor and Pensions Committee and the
leading House bill at more than $1 trillion.
Mr. Baucus achieved his apparent savings partly by omitting the "public option" dear
to liberal hearts, partly by not covering all of the currently uninsured. But he
achieved them mostly by front-loading tax increases and cuts in Medicare and
Medicaid, but delaying most spending increases for two and a half years. Once the
spending increases went into effect, they rapidly would overwhelm the "savings." By
the 11th year, the Baucus bill would add massively to the deficit.
There was a problem with this gimmick, though. Mr. Baucus proposed to save money in
Medicare by gutting the Medicare Advantage program, in which 23 percent of seniors
are enrolled, and by slashing the payments doctors and hospitals receive for
treating Medicare patients.
Medicare currently reimburses doctors only 94 cents for each dollar of health-care
services provided. To slash payments another 21.5 percent, as Mr. Baucus proposed,
would not be popular with doctors. And if payments were slashed, many doctors who
now treat Medicare patients would stop seeing them, which would not be popular with
Medicare patients.
To fix this problem, Sen. Debbie Stabenow, D-Mich., proposed to block the Medicare
reimbursement cuts for 10 years. The logical thing to do would have been to offer
the Stabenow proposal as an amendment to the Baucus bill. But if that were done, the
cost of the Baucus bill would rise by $247 billion over 10 years, according to the
CBO. Democrats could no longer claim it was deficit neutral.
To Mr. Reid, the solution was to offer the Stabenow measure as a separate bill and
pretend it had nothing to do with the Obamacare plan. But last Wednesday, 13
Democrats joined all the Republicans in opposing this fiscal sleight of hand.
The defeat made Mr. Reid look like a putz. Majority leaders aren't supposed to bring
measures to the floor unless they have the votes, and he got beat bad. (Mr. Reid
needed 60 votes to take up the Stabenow bill; he got 47.)
In defeat, Mr. Reid then acted like a putz. He blamed the loss on the failure of the
American Medical Association to deliver Republican votes.
"Reid told colleagues that the AMA said it could deliver 27 Republican votes for the
legislation, according to two Senate Democratic lawmakers, who spoke on condition of
anonymity," The Hill newspaper reported.
Even if that were true — the AMA says it isn't — it's not a very politic thing to
say about a lobbying group whose help Mr. Reid will need to get Obamacare passed.
(Only about 17 percent of physicians belong to the AMA, a fact which journalists who
write about health care ought to note, but rarely do.)
Many Republicans do support giving doctors relief from Medicare reimbursement cuts.
It's the fiscal sleight of hand to which they object.
The defeat leaves Democrats between a rock and a hard place. They still must merge
the Baucus bill with the much more expensive HELP version. The combined bill
probably can't be passed unless the Medicare reimbursement problem is fixed, but
that problem can't be fixed without making it plain that Obamacare will balloon the
deficit.
Making the deals and twisting the arms necessary to get this done might be beyond
the abilities of even the greatest Senate leader, Lyndon Johnson. And Harry Reid is
no LBJ.
Yuval Levin, who monitors health care issues for the Ethics and Public Policy
Center, summed up the situation: "[The] vote showed [Senate Democrats] a leader
unsure of himself, lacking an accurate vote count, and surprised by developments on
the Senate floor."
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