This is not a rant about healthcare legislation, or a lack thereof. It is not even about the ill-conceived sequencing of healthcare legislation and tax reform. My take is that tax reform was more important, would give a chance to generate some bipartisan efforts that could be exploited going forward. I will admit I did not anticipate a leadership crafting bills in secrecy from even their own rank and file.
Okay. Back to the larger issue, again from my perspective. I read the FY 18 budget document from Chairman Black, the so-called Building a Better America. Now I fully understand these documents are meant to be vague, outlines really with more policy coming from appropriations bills. That’s the way things work, and maybe that is the reason things are not getting further.
One aspect that earned my wrath this week was the Policy statement on Medicare (Section 511, p.92). Like many of the policy statements this is chock full of generic language that does not really say much. The language is the same as years before with slightly updated numbers. The first part of the section is just a statement of findings so that is not too distressing really. But it is in the next part, the “Assumptions (page 94)” where we should be seriously aggravated.
“This concurrent resolution assumes transition to an improved Medicare program that ensures-“. Let’s stop here for a moment. We are going to assume the transition to an improved Medicare. How is that possible? As an economist it is part of the business that we make assumptions, and I preach to my students to always watch out for assumptions that drive the result. And more than anything do not assume your result! So let’s just assume an improved Medicare. Let’s assume improved healthcare. Let’s just assume all the issues away.
The section continues:
“(1) Medicare is preserved for current and future beneficiaries;
(2) future Medicare beneficiaries may select from competing guaranteed health coverage options a plan that best suits their needs;
(3) traditional fee-for-service Medicare remains a plan option;
(4) Medicare provides additional assistance for lower-income beneficiaries and those with greater health risks; and
(5) Medicare spending is put on a sustainable path and becomes solvent over the long term.”
The first point is just a statement that they are intending to keep medicare. The second sets out an interesting setup that says there will be a set of plan options as well as, point 3, the traditional Medicare system continuing. Choice in healthcare is not a problem from my perspective so that is fine. Point 4 that there will be some additional assistance for those with lower incomes does not bother me either. Then we get to point 5 and I had to call people into my office, let’s assume that medicare spending is put on a sustainable path despite all public comments about the problems, and a lack of any meaningful solutions offered by legislation, we are going to assume this will work. This is a bridge too far. The policy part of my brain just requested a leave, it cannot work under these conditions anymore.
And then I made it even more upset. This language, for all intents and purposes is identical to the language in the legislative text of the last four budget documents (go by section title, not section number is you wan to check). So now we are not saying anything relevant in terms of policy, and we are plagiarizing ourselves. What probably aggravates me the most is we are not even plagiarizing a plan. It is a plan to make a plan, if even that. This is why nobody seems to make any progress on their agenda, regardless of ideological alignment.
Alright, now I can go back to statistical and policy analysis.
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