July 23, 2014 SIGN IN | REGISTER

Paralysis by Analysis

Thus, when the BBA affected health care providers more severely than had been forecast, Congress restored most of the money in 2000 and 2002. The (deservedly) much-maligned “doughnut hole” in the Medicare drug benefit (created in the first place as a way to game the CBO estimation process) may well be fixed as part of health reform — if CBO doesn’t torpedo that process. Congress convenes every year and adopts a federal budget (almost) every year. So, instead of treating CBO estimates like the Ten Commandments, we should treat them like the informed wild guesses they actually are. And the credibility of its director on the importance of an issue such as taxation of employee benefits — about which most economists, but few real people, agree — should be taken as no more than one person’s opinion, not as consensus or the product of any rigorous process.According to the Institute of Medicine, the absence of health insurance kills 18,000-20,000 Americans a year (the significant noneconomic costs of which are not part of the CBO’s calculus). Thus the moral — and rational — thing to do is not panic at the CBO’s pronouncements, but instead recognize that any important new government program will inevitably require mid-course fixes and corrections. For example, the House bill contains standby tax provisions that go into effect in 2015 or 2016 in the unlikely event that the CBO turns out to be right. There’s a better than even chance it’ll be wrong, and that those new taxes will never be necessary. In the meantime, lives will have been saved and the average American family will be much better off.Bruce Vladeck was an administrator of the Health Care Financing Administration when the Balanced Budget Act passed and is now senior adviser to Nexera Consulting, a wholly owned subsidiary of the Greater New York Hospital Association.

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