‘First, do no harm’

Democrats in Congress hoping to pass sweeping health care reform, apparently without any Republican support, should remember the dictum above, associated with Hippocrates.

Passing anything — if that anything is bad legislation — is not better than nothing. And the massive plan now being contemplated in Washington, D.C., is a bad budgetary policy.

There are several points to note as the debate continues:

Parties’ interests versus public interest:

Republicans haven’t been just “the party of no,” as Democratic leaders have claimed. Republicans have offered a variety of reasonable ideas for incremental health care reform. President Barack Obama acknowledged as much when he agreed to include some of the GOP proposals in his latest plan for health care reform.

Still, given the polls that show strong public opposition to the health care legislation, Republicans have little incentive to cooperate. Let Democrats commit political hari-kari on their own.

For their part, Democratic leaders seem to hope some of their members will calculate this way: “I’m not likely to be re-elected this year, so I might as well go out with a bang and help Obama get legacy legislation passed. Let others figure out how to pay for it.”

Reconciliation ruckus:

Then there’s reconciliation — the convoluted process Democrats are threatening to use to pass the bill. GOP indignation on this score is hypocritical, since Republicans used it to pass President George W. Bush’s tax cuts, among other things. It’s been used by both parties under every president since Jimmy Carter.

Reconciliation may not be Lucifer’s legislative tool, but that doesn’t mean using it to pass this legislation is a good idea.

Budget gimmickry:

A primary objection to Obama’s plan is the fact that it depends on a tax on “Cadillac” health insurance plans to cover increased spending. But the tax won’t take effect until 2018, while the spending would begin almost immediately. Furthermore, there’s no guarantee the tax would be implemented eight years from now, or that the revenue would be there if it were implemented. Start taxing them, and companies will quickly drop their Cadillac plans.

The president’s proposal also uses 10 years of tax increases and program cuts to pay for only six year’s worth of spending, a smoke-and-mirrors gimmick to make the bottom line look better.

Then there’s the projected cuts in Medicare reimbursements for doctors, not included in the president’s plan, but still critical for keeping Medicare spending in check. However, as outlined in a column on the facing page, the Medicare reimbursement cut has become a bargaining chip that Congress annually restores. Will the cuts be made or not? Congress regularly leaves doctors and seniors who depend on Medicare unsure of what will happen next month, much less a decade from now.

How much will it cost?

About $2.3 trillion over the first 10 years, says Paul Ryan, the Wisconsin congressman who is the GOP expert on budget issues. His estimates appeared in The Wall Street Journal Thursday.

Not so, say Peter Orzag and Nancy-Ann DeParle, the president’s top budget and health care aides, who provided their side in The Washington Post Friday. They say Obama’s plan will not add a dime to the federal deficit in the first decade, and will actually reduce the deficit about $1 trillion over the second 10 years.

Who’s right? Both sides use independent government entities to back up their claims. How are average Americans to wade through such disparate numbers to find the truth? It’s not easy.

Orzag and DeParle made a critical point: “Even if we thought we had the answer for containing costs and improving quality today,” they said, “that would quickly change as health care evolved.”

Exactly so. No one can predict the cost with precision. But Ryan and others raise reasonable questions about what may occur.

What should we do?

The White House team cites a number of programs in the Obama plan that test “what works and what doesn’t.” Those sorts of pilot programs — which can easily be revamped if they prove ineffective or far more costly than anticipated — are good public policy. They should be enacted on their own.

But it’s not good policy to adopt a massive piece of legislation, with dubious revenue streams and questionable budget cuts, that will be almost impossible to eliminate once it is approved.

First, do no harm.


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