December 9 2010
I thought Megan McArdle's commentary on the doc fix in the Atlantic blog was funny.
First, she quotes her husband (who writes for the Reason blog). He says:
Democrats argued that the doc fix was a separate issue, unrelated to the new law and therefore unnecessary to include in the bill or the cost estimates. But that was pretty hard to believe: Reports indicated that Harry Reid had used the doc fix to buy support for the health care overhaul from the American Medical Association, and an early draft had included a fix. The cost proved to be too much.
Then he goes on to explain that the deal that's now on the table would increase certain penalties in ObamaCare health exchanges (in 2014) to make some money available for the doc fix. Basically, if you don't report your income correctly and you end up with an ObamaCare subsidy that's too big, you'll pay a penalty. The health reform law capped those penalties at $250 per person and $450 per family, but the current deal would increase the caps to anywhere between $600 and $3,500, depending on income.
Then the missus chimes in:
He tactfully neglects to mention that his wife was one of the people arguing that the "doc fix" had nothing to do with health care reform. And I suppose you could still argue that it doesn't--after all, as I understand it, the doctors got played. They were expecting a permanent fix in exchange for their support (or at least their silence), not the same one-year fix they always get.
But as Peter notes, the health care bill used up all the normal pay-fors, which is why we've got this bizarre time-shifting deal. In order to pay more for doctor's visits next year, we're revising the subsidies that health-insurance buyers will receive in 2014. I'd argue that if you're balancing the cost of the doc fix with changes to the exchange subsidies three years hence, the doc fix should have been part of the bill.
All other issues aside, this strikes me as a pretty bad precedent. The doc fix will need to be paid for in 2012, too--shall we start siphoning funds out of the 2020 budget to pay for it?
The docs got "played," but will they get paid?
This whole doc fix problem goes to show that if "the people" can't afford health care, the government can't afford it for them. The government doesn't make money. Although it was proclaimed to "pay for itself," ObamaCare was full of smoke and mirrors from the start. (Click here for a great explanation.) We can rearrange our current budget to try to fund it, we can arrange our future budget to try to fund it, or... (my vote) we can talk seriously about repealing it.