>> They are projecting that yes, it will go down.
There is no such projection, at least not by CBO. CBO was TOLD to score the bill making certain assumptions, including the following, pertaining to the decade beginning 10 years hence (when the plan is fully operational):
a) The long-term assumptions are that the plan remains unchanged, which never happens. Says Elmendorf, "These longer-term calculations assume that the provisions are enacted and remain unchanged throughout the next two decades, which is often not the case for major legislation. For example, the sustainable growth rate (SGR) mechanism governing Medicare’s payments to physicians has frequently been modified (either through legislation or administrative action) to avoid reductions in those payments, and legislation to do so again is currently under consideration in the Congress. The legislation would put into effect a number of procedures that might be difficult to maintain over a long period of time. Although it would increase payment rates for physicians’ services for 2010 relative to those in effect for 2009, those rates would be reduced by about 23 percent for 2011 and then remain at current-law levels (that is, as specified under the SGR) for subsequent years.
So, we get down the road a couple years and all physician fees are cut by 23% to make these numbers work. Obviously, you can't do that, and you won't. There goes the budget. We're talking 100s of billions.
b) "At the same time, the legislation includes a number of provisions that would constrain payment rates for other providers of Medicare services. In particular, increases in payment rates for many providers would be held below the rate of inflation (in expectation of ongoing productivity improvements in the delivery of health care). "
Okay, so once you're past the DocFix, the bill assumes that everyone -- hospitals, etc., are going to be able to survive without cost increases due to general price level increases. You think that is viable? Of course it is not.
c) "The projected longer-term savings for the legislation also assume that the Independent Medicare Advisory Board that would be established by the bill is fairly effective in reducing costs—beyond the reductions that would be achieved by other aspects of the bill—to meet the targets specified in the legislation."
Here's the big one. The IMAB is going to CUT COSTS of Medicare. Something that has never happened in history. And the cutting has to be aggressive. It is an absurd assumption ON ITS FACE.
d) Referring to the reduction in the growth rate of Medicare costs, he says, "Whether such a reduction in the growth rate could be achieved through greater efficiencies in the delivery of health care or would reduce access to care or diminish the quality of care is unclear."
So, there you go. The head of CBO says, in effect, "We don't know whether this bill would save money through efficiency gains, or just cut the hell out of benefits; could go either way."
Elmendorf, God love him, is trying his best to tell us: "Don't believe this shit. I'm doing what I'm required to do under the law, but by god, don't believe this SHIT."
He couldn't be clearer. |
