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 doesnt 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 persons 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 CBOs calculus). Thus the moral and rational thing to do is not panic at the CBOs 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. Theres a better than even chance itll 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.
Rep. Eric Swalwell, D-Calif., walks on Broadway after a Future Forum with young entrepreneurs in the Flatiron District of New York City, April 16, 2015. Reps. Steve Israel, D-N.Y., Seth Moulton, D-Mass., and Grace Meng, D-N.Y., also attended.