I originally wrote this as a Facebook note on March 24, 2009, and have referred to it multiple times since then. There are a couple of issues that need discussion, not least the fact that the Chait piece does, in fact, link to Rep. Paul Ryan's CBO scoring (though that makes his contemporaneous belief that savings were going to occur due to Obamacare even less tenable). As well, there have been no fewer than eight votes on the Medicare Fee-For-Service "Sustainable Growth Rate" and its successor calculations – all of which have subsequently failed. I will write a followup on this topic eventually.
One of the most irritating things I remember about the buildup to the war in Iraq was how thoroughly predictable, and thoroughly mendacious, the whole affair was; there was never any compelling evidence in support of the idea that Saddam Hussein had Weapons of Mass Destruction. Sure, they trotted Colin Powell in front of the dais, but for me it was perfectly plain that there was no there there, Powell reading from a script a dozen or so Q.E.D.'s away from reality the whole time. It was a speech written by an alcoholic, delivered by a team player who clearly disbelieved every word but was duty-bound to give it his best shot.
In the days leading up to the war, you would be hard-pressed to find a bigger cheerleader for it than the New York Times columnist Tom Friedman. Glenn Greenwald, long after that war got started and became a disaster, noticed Friedman's role in the buildup, aided by an unreality field that Friedman himself was all too happy to build:
Just ponder that: Tom Friedman supported the invasion of Iraq even though, by his own reasoning, that war was being done the "wrong way" and would thus -- also by his own reasoning -- create nothing but untold damage on every level. And he did so all because there was some imaginary, hypothetical, fantasy way of doing the war that Friedman thought was good, but that he knew isn't what we would get.
I get the same sense of unreality these days about the health care debate. My friend Steve Timberlake recently mentioned Jonathan Chait's alleged debunking of the complaints that the so-called "doc fix" (about which, more presently) would undo all the savings from the health care bill. It basically mirrors a Washington Post blog piece Ezra Klein wrote back on March 1.
Chait gets his snark on with the claim that Congressman Paul Ryan is being "disingenuous" when the latter says that the bill is "double-counting" savings. I'm not sure about how he gets to "double", but there certainly is a shell game going on, and the various sniff tests say that this time, it's the health care bill's proponents who are being shifty.
Here's Chait (emboldening is all mine) regarding this "double-counting":
This is categorically false. Democrats did not instruct the CBO to credit savings from reducing physician pay toward the health care bill. Every dollar of new health care spending is offset by different savings. The purported cut in physician pay is not part of those savings. There are parts of the CBO score you can legitimately suggest underestimate the cost of health care reform -- most prominently, the slowdown in value of the tax credits over the second ten years. (I'd argue that there are places where CBO is underestimating cost savings, as well.) But the doc fix is simply not a legitimate complaint.
Except that, if you look at the latest CBO report on the health care bill (PDF), it specifically calls out, in Table 2 on page 8, a line item labeled "Reductions in Annual Medicare FFS [Fee for Service] Payment Rates".
If Chait — or Klein, who makes exactly the same argument — wants to explain why that line item is in there, I'm all ears. But the twin facts that (a) neither article provides a link to the CBO summary, and (b) the AMA and AARP aren't bitching about "reform" are both strong indicators that this is utter fabrication.
That Medicare physician reimbursement looks awfully similar to the doc fix that Nancy Pelosi has indicated is going to get passed. The "savings" are 100% illusory, and always were. But maybe that's the plan. Nobody's fired Tom Friedman yet, have they?
Update 3/25/2009: One of the links I wanted to present here but forgot last night was the CBO analysis of HR 3961 (PDF), the so-called "doc fix" bill. What's especially interesting about this is that it shows a line item called "Medicare Physician Fee Schedule" with totals running to $194.6 billion. The claimed savings for Medicare price cuts in the health care bill just passed (FKA HR 3590) is only $186 billion. That means they're $8.6 billion more over that period than if Congress did nothing.
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