Maybe because I have two teenage daughters who dream about a big wedding with all of the bells and whistles (way, way in the future . . . of course!), the Congressional Budget Office reminds me of the frugal father who adds up the tab and is forced to put the brakes on a beloved daughter's plans for the "perfect" wedding.
The Congressional Budget Office told the Senate that the cost of their health reform legislation could be about 2.6 trillion dollars over the next decade - and still leave tens of millions without health insurance. The CBO also told Congress that plans to expand coverage to more Americans could cause an unsustainable increase in the federal deficit - unless offset by enforceable cuts in spending - and expressed skepticism that investments in prevention would achieve substantial savings. It acknowledged that primary care is associated with lower costs, but suggested that increasing the numbers of primary care physicians would help only if linked to policies to curb the numbers of non-primary care specialists:
"One study of the relationship between Medicare spending and the composition of the workforce of physicians found that, with the total number of physicians held constant, states with more general practitioners had lower spending. Achieving that outcome, however, involves reducing the number of specialists in line with increasing the number of primary care physicians, and the mechanism for accomplishing that change (for example, the appropriate adjustments in payment policies) is unclear. Savings would be less likely if the number of specialists remained the same while the number of primary care physicians increased."
The CBO report is causing Congress to hedge on its plans to have legislation passed before the August recess. The Democratic majority also is looking for ways to scale back how many would be covered, to find more revenue (tax) increases, and to find other measures that to save money - such as more cuts in payments to hospitals and other providers. The problem, though, is that tax increases and provider cuts will increase the level of opposition.
As Congress looks for ways to trim the cost, I worry that it will look in the wrong places. For instance, plans to spend more money to increase payments to primary care physicians and to train more of them could be at risk. One can anticipate the "we wanted to do more, but we couldn't find the money" excuse.
On Thursday, the leaders of the American College of Physicians, American Academy of Family Physicians, and the American Osteopathic Association are coming to Washington to make the case to Congress that failure to fund primary care will inevitably cost the country far more in the longer run . . . even if the CBO won't "count" such savings in the budget.
Today's questions: do you think Congress should scale back its plans because of the cost? How?