In my most recent post on The New Republic’s The Treatment, I question the obsession by those in the Washington, DC health reform conversation–both legislators and media–over the “scores” provided by the Congressional Budget Office (CBO) on specific proposals.
It’s important to know what a health reform will cost. I think it’s equally importnat to know what that reform actually buys us, in terms of help for struggling families dealing with insurance premiums, cost-sharing, and medical debt.
In my piece, I invoke the “Moneyball” approach of the Oakland As, which looks at statistics that are more relevant to scoring runs and winning games. (The photo is of Nick Swisher, one the stars of the book, who made his way from the Sacramento RiverCats to the Oakland As and is now with the New York Yankees.) I propose that the CBO score be accompanied by other stats, including the CBI and the IOU. From the article:
It seems to me we need some new (or at least additional) metrics to properly evaluate these health reform proposals.
Every time we mention the impact of a health reform proposal on the federal budget with a CBO score, we should also give an estimate of how the proposal impacts a family budget. Call it the Consumer Budget Impact–the CBI. It would indicate how a family’s premiums would go up or down–and how much their exposure to significant medical debt would decline.
True, no single number can capture this. So we may need to come up with a set of numbers and perhaps compile them into an index, the way Dow Jones uses a mix of stocks to demonstrate the performance of the market as a whole. Elected officials should know if John’s family at just over the federal poverty level will be able to get coverage–and if we are expecting too much for Alice the 60-year old who is around 400 percent of the poverty level.
Remember, the subsidies in health reform don’t simply help the uninsured get coverage; they also help people who already have coverage but are struggling to pay for it. Think of the early retiree who spends over $1,000 a month, and thus over a third of his or her limited income, to keep coverage. Or the underinsured young adult who can only afford the bare-bones, high-deductible health plan. Or the workers who would lose coverage if not for the assistance and new affordable options their employer is being offered.
All of these people are insured, but in a way that is inadvisable and/or unsustainable. Depending on their income, they and millions of others will get help, so they don’t have to pay over a certain percentage of their income for premiums to get a standard package of benefits.
When the Senate Finance Committee comes out with its bill, I hope the political conversation concentrates less on the CBO and if they met this arbitrary $1 trillion budget target, and more on IOUs and what would be the impact on family budgets, and how many people are helped, both insured, underinsured, and overstretched.
That’s what voters will care about–just like baseball fans know the win-loss record of their team, more than the cost of the team’s operations. Both our elected officials and the media need to do better focusing on the score that matters.