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Published: Tuesday, 10/27/2009

Reid weaves 'tangled web' to hide health-reform costs

"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. Recently, 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.

But there was a problem with this gimmick. 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 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 her proposal as an amendment to the Baucus bill.

However, 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 then, 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 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."

Jack Kelly is a columnist for The Blade and the Pittsburgh Post-Gazette.

Contact him at: jkelly@post-gazette.com



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