Thursday, November 05, 2009

Health Reform Faces Moment Of Untruth By Sen. Tom Coburn and Rep. Paul Ryan



As Congress works to "make history" with health care reform, the American people have a far more sensible ambition for policymakers: get a grip on our unsustainable fiscal course.

By 2-to-1, Americans continue to believe that Congress should address the deficit first, then health care. Yet the best that Congress has come up with to address our entitlement and fiscal crisis is to create a costly new open-ended entitlement.

The American people suspect what we know to be true: Congress really has no idea how to pay for "reform," or anything else for that matter. Fiscal restraint remains off the agenda, while there is of course the desire to appear to be fiscally responsible.

Behind closed doors, negotiators have been performing budget gymnastics. House and Senate leaders have been fudging their cost estimates to meet the president's demand of not adding a dime to the deficit.

For instance, the bill won't be fully implemented until 2013, but tax hikes will take effect immediately. This gimmick will produce 10 years of revenues but only seven years of cost. Once fully implemented, however, the plan will cost nearly $2 trillion over 10 years — double the $900 billion touted as a passing grade from the Congressional Budget Office.

Still, congressional leaders are sticking to their talking point. "We're very excited by the CBO scores," Speaker Nancy Pelosi said gleefully when the plan's Enron-style accounting produced a positive score. The CBO, however, is less excited about Congress' fiscal management. As it recently told Congress, "Slowing the growth rate of outlays for Medicare and Medicaid is the central long-term challenge for federal fiscal policy."

President Obama seems to agree. He recently said: "If we do nothing to slow these skyrocketing costs, we will eventually be spending more on Medicare and Medicaid than every other government program combined. Put simply, our health care problem is our deficit problem. Nothing else even comes close."

He's right, which makes the fiscal irresponsibility of the "reform" process all the more breathtaking. The current bills dump half of the uninsured in Medicaid, create new federal handouts paid for by taxpayers, and build on the unsustainable Medicare status quo while cutting what's working best in Medicare.

Budget gimmicks are not only disingenuous, but will harm our economy. Sustained economic growth is not possible should Congress continue to pile debt on top of debt, or attempt to tax our way out of our fiscal hole.

As the CBO reminded Congress, "If spending grew as projected and taxes were raised in tandem, tax rates would have to reach levels never seen in the U.S. High tax rates would slow the growth of the economy, making the spending burden harder to bear."

Especially troubling is the fact that Congress' long-term cost estimates of government-run health programs have been notoriously inaccurate. When Medicare was created, Congress predicted it would cost $12 billion in 1990. It cost $110 billion in 1990. Medicaid now costs 37 times what it did when it was launched in 1965; Medicare 16 times, both adjusted for inflation.

If the current reform bill outperforms Medicare and Medicaid and grows by a factor of 10, it will cost $1.8 trillion every year. If it follows the path of Medicaid, it will cost $6.7 trillion every year.

What is at stake in this process is not merely a lower standard of living for future generations, but a decline of freedom at home and abroad. We are risking our own national economic stability and security if we continue — through excessive borrowing — to hand potential adversaries leverage over our foreign and domestic policy.

We believe health care needs to be reformed, which is why earlier this year we introduced detailed legislation, the Patients' Choice Act. We drafted our plan cognizant of the fact that we already spend more than 2 1/2 times per person on health care than any other country in the world.

If our health care sector were a stand-alone economy, at $2 trillion it would be the eighth largest in the world, ahead of countries like India and Russia. We don't need to spend more, nor do we need to raise taxes. Instead, we need to direct resources to actual health care rather than the bureaucratic management of health care.

The current reform product does not meet the test of either real reform or fiscal responsibility. Nor does it represent the best of both parties. It represents the frustrated ideological ambitions of one party that believes the way to pull the welfare state back from bankruptcy is by expanding it.

We can fix what's broken in health care without breaking what's working, and without creating a huge new entitlement program that will accelerate the bankruptcy of this country. The American people deserve better.

• Coburn, a practicing physician, is the junior senator from Oklahoma.

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