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Ezra Klein writes an opinionated blog on economic policy, cap and trade, health care reform and pretty much anything else you can attach a chart to.

Democrats get the bill, and the score, they needed

The question people generally ask about the final health-care reform vote is, "Won't it be politically difficult for many House Democrats to vote yes?" But with the release of the CBO report (pdf), I'd flip that question a bit: Won't it be substantively difficult for many House Democrats to vote no?

If you're a liberal House Democrat, here's what you'd be voting against: Legislation that covers 32 million people. A world in which 95 percent of all non-elderly, legal residents have health-care coverage. An end to insurers rescinding coverage for the sick, or discriminating based on preexisting conditions, or spending 30 cents of each premium dollar on things that aren't medical care. Exchanges where insurers who want to jack up premiums will have to publicly explain their reason, where regulators will be able to toss them out based on bad behavior, and where consumers will be able to publicly rate them. Hundreds of billions of dollars in subsidies to help lower-income Americans afford health-care insurance. The final closure of the Medicare Prescription Drug Benefit's "doughnut hole."

If you're a conservative House Democrat, then probably you support many of those policies, too. But you also get the single most ambitious effort the government has ever made to control costs in the health-care sector. According to the Congressional Budget Office, the bill cuts deficits by $130 billion in the first 10 years, and up to $1.2 trillion in the second 10 years. The excise tax is now indexed to inflation, rather than inflation plus one percentage point, and the subsidies grow more slowly over time. So one of the strongest cost controls just got stronger, and the automatic spending growth slowed. And then there are all the other cost controls in the bill: The Medicare Commission, which makes entitlement reform much more possible. The programs to begin paying doctors and hospitals for care rather than volume. The competitive insurance market.

This was a hard bill to write. Pairing the largest coverage increase since the Great Society with the most aggressive cost-control effort isn't easy. And since the cost controls are complicated, while the coverage increase is straightforward, many people don't believe that the Democrats have done it. But to a degree unmatched in recent legislative history, they have.

The Medicare Prescription Drug Benefit didn't try to offset its costs. It just increased the deficit. And Medicare and Medicaid were passed in the days before the Congressional Budget Office even existed. For health-care reform, Democrats have gotten the toughest scorekeeper in Washington to bless their effort, and though many don't think that's good enough, it's a lot more than anyone else has ever done.

People pay a lot of attention to the difficult politics of health-care reform, but at the end of the day, the task of writing the policy will be seen as the harder, and more consequential, element of this effort. But it worked. Democrats got the score they needed, and now they can go to their liberals and say that this is closer to universality than we've ever been, and they can go to their conservatives and say this does more for deficit reduction than has ever been done, and both things will be true.

If this bill does pass on Sunday, that, and not deals or polls or rides on Air Force One, will be why.

Blog post originally published here.

By Ezra Klein  |  March 19, 2010; 11:06 AM ET Save & Share:  Send E-mail   Facebook   Twitter   Digg   Yahoo Buzz   Del.icio.us   StumbleUpon   Technorati  
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Pure fantasy.

Posted by: Phillip0829 | March 20, 2010 12:06 AM
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Did this man read the CBO report ?. There are so many maybe's that it is a joke. Would Mr Klein be willing to give up his job & assets if he is wrong?. Thats what he & the president are asking of small business and senior citizens.

Posted by: mct1 | March 19, 2010 4:40 PM
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Exact Same Style weekend event by US Congress sent HelathCare bill to US Senate in LATE 2009. Several Problems then, US Congress was NOT In session that day/NIGHT & photos show Person with Grey hair, heavy set & Mustache, identified in News Release as US Congressional Sgt at Arms, whom Lost Job (fired) about 6 Years ago. Recently, earlier today, picture on internet with Same Heavy set gray haired & Mustached defunct Sgt at ARMS, with group in US Congress Floor area with Hon Pelosi, Seems that specific BAD guard Knows how to enter US Congress when out of session & Pull Spoof Photo session that becomes foundation for HealthCare bill Moving Bill on in Process, complete Fraud, Public Seems NOT smart Enough to UnderStand Mess has fallen into. terrible Crime, Right in Front of US Public Eyes.
Murder Is NOT Health Care & Prsent Bill Is Harvest of People whom bought BAD Package, NOT HealthCare At ALL. Entertainment Murder In isolated Place called hospitol. Inside Foundation of present HealthCare, Is HATE of Citizens of United States of America Lawyers Are that Way with Others. Whole Lie now called health Care Bill Needs Be Thrown Out, Defeated. Congress Is About To Criminalize HealthCare Process Further than every before. Public Being Duped & Repeat of first events in US Congress in Lat 2009. US CongressPeople Are NOT Above Law.

Signed:PHYSICIAN THOMAS STEWART von DRASHEK M.D.
GEORGE MASON UNIVERSITY 1984 to 1989.

Posted by: thomasxstewart1 | March 17, 2010 9:06 PM | Report abu

Posted by: ThomasStewart1 | March 19, 2010 12:06 PM
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