{"id":443920,"date":"2010-03-18T14:50:17","date_gmt":"2010-03-18T18:50:17","guid":{"rendered":"http:\/\/www.theatlantic.com\/business\/archive\/2010\/03\/first-thoughts-on-the-cbo-score\/37720\/"},"modified":"2010-03-18T14:50:17","modified_gmt":"2010-03-18T18:50:17","slug":"first-thoughts-on-the-cbo-score","status":"publish","type":"post","link":"https:\/\/mereja.media\/index\/443920","title":{"rendered":"First Thoughts on the CBO Score"},"content":{"rendered":"<p>As fate would have it, on the day that the CBO report is released, I am in standby hell, and running low on laptop juice. &nbsp;So my thoughts on the CBO score, and the revised reconciliation bill, are necessarily somewhat preliminary. &nbsp;But here is what I&#8217;ve noticed so far: <\/p>\n<div><\/div>\n<div>1) &nbsp;Thanks to reconciliation instructions, they needed to improve the budget impact by at least $1 billion in the sidecar. &nbsp;They improved it by exactly $1 billion. &nbsp;Which goes back to what I&#8217;ve now said several times: the CBO process has now been so thoroughly gamed that it&#8217;s useless.<\/div>\n<div><\/div>\n<div>2) &nbsp;The proposed changes increase spending dramatically, most heavily concentrated in the out-years. &nbsp;The gross cost of the bill has risen from $875 billion to $940 billion over ten years&#8211;but almost $40 billion of that comes in 2019. &nbsp;The net cost has increased even more dramatically, from $624 billion to $794 billion. &nbsp;That&#8217;s because the excise tax has been so badly weakened. &nbsp;This is of dual concern: it&#8217;s a financing risk, but it also means that the one provision which had a genuine shot at &#8220;bending the cost curve&#8221; in the broader health care market has at this point, basically been gutted. &nbsp;Moreover, it&#8217;s hard not to believe that the reason it has been moved to 2018 is that no one really thinks it&#8217;s ever going to take effect. It&#8217;s one thing to have a period of adjustment. &nbsp;But a tax that takes effect in eight years is a tax so unpopular that it has little realistic chance of being allowed to stand.<\/div>\n<div><\/div>\n<div>3) &nbsp;As I expected, the size of the magic asterisk&#8211;the modern equivalent of David Stockman&#8217;s infamous &#8220;savings to be named later&#8221; in the Reagan budgets&#8211;has had to be beefed up to offset the new spending.<\/div>\n<div><\/div>\n<div>4) &nbsp;Medicare Advantage is being effectively outlawed&#8211;in some areas, the reimbursements will actually be below those of the fee-for-service programs.<\/div>\n<div><\/div>\n<div>5) &nbsp;A disturbingly high percentage of the revenues still come from insurance premiums for other programs. &nbsp;About $53 billion of the net deficit reduction is from Social Security taxes collected on the wages people will now be getting in lieu of health care benefits. &nbsp;But since those contributions raise the amount Social Security will eventually have to pay out, the Republicans convincingly argue that this is not true &#8220;deficit reduction&#8221;; it&#8217;s just deficit shifting.&nbsp; Ditto the premiums for the new long-term care insurance.<\/div>\n<div><\/div>\n<div>6) &nbsp;Ultimately, this rests on the question: are we really going to cut Medicare? &nbsp;If we&#8217;re not, this gargantuan new entitlement is going to end up costing us about $200 billion a year next decade, which even in government terms is an awful lot of money. &nbsp;There are offsetting taxes, but they&#8217;re either trivial or likely to be unpopular&#8211;look forward to a 4% rent increase when your landlord has to stump over the same amount for the new tax on rents. &nbsp;Then look forward to repeal of same.<\/div>\n<div><\/div>\n<div>I think this is a fiscal disaster waiting to happen. &nbsp;But no one on the other side cares, so I&#8217;m not sure how much point there is in saying that any more.<\/div>\n<p><br clear=\"both\" style=\"clear: both;\"\/><br \/>\n<br clear=\"both\" style=\"clear: both;\"\/><br \/>\n  <a style='font-size: 10px; color: maroon;' href='http:\/\/www.pheedcontent.com\/hostedMorselClick.php?hfmm=v3:94b290872545dfdda8dfe3803f567f3f:cRoJqy3aA0dH%2FsJAp0Amr98U%2BWDVPcc6gP9Su6nNh7smpOu67ynW4pZOaKShYCnP53tUtbWIVtje'><img border='0' title='Email this Article' alt='Email this Article' src='http:\/\/images.pheedo.com\/images\/mm\/emailthis.png'\/><\/a><br \/>\n  <a style='font-size: 10px; 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