The big news on federal health reform this week was that the Congressional Budget Office (CBO) put forward a comprehensive (if not dense) set of papers detailing “Key Issues in Evaluating Major Health Insurance Proposals.” These documents may be more important to health reform than any proposal by Senator Baucus, Senator Kennedy, Representative Conyers, Representative Waxman, or even President Obama.
It’s not a health reform plan. But it’s how the health plan will be evaluated.
As we have reported before, Peter Orzag is leaving an important legacy at CBO, before he swtiches to President-elect Obama’s Office of Management and Budget (OMB). He increased the health policy staff there, and has now put forward their thinking about how they intend to look at these issues.
Many, including Ezra Klein, report about CBO’s “devastating” role in the Clinton health plan in 2008. We have other examples: During California’s reform debate earlier this year, the state’s CBO-equivalent, the LAO, was asked to evaluate AB x1 1 (and then later, SB840). It was expected–after all, anything that goes on the ballot is required to have an LAO analysis in the voter guide. When nobody knew what the LAO would say, because there was no previous engagement with the drafters of health reform. It’s like turning in a test, and having no idea what criteria the teacher would be using to determine a grade. (We had a problem with the analysis–of what was asked: risks without context, without benefits–and what was not asked: the comparison with the status quo.)
What the CBO has published is like getting the teacher’s manual to the class textbook. We may not like the answers, but at least we know what their assumptions are. There is a more transparent process, which also allows us to perhaps challenge some assumptions: Can we count savings from preventative care efforts? What are the assumptions of the rate of growth of health costs over five years? What is the CBO’s understanding of the status quo?
For a lot of people interested in health reform, this will be required reading. I haven’t read it yet, so we’ll post later about our thought, and what we disagree with… but it’s good to be having the conversation now, rather than later. The process bodes well for the prospects of health reform.