CBO won’t cover up Bi­den’s plans

Times Standard (Eureka) - - OPINION - By Phil Ker­pen Phil Ker­pen is the pres­i­dent of Amer­i­can Com­mit­ment and the Com­mit­tee to Un­leash Pros­per­ity. Ker­pen can be reached at phil@ amer­i­can­com­mit­ment.org.

It be­came a ma­jor scan­dal when Philadel­phia-based re­searcher Rich We­in­stein un­cov­ered video of Jonathan Gru­ber, the ar­chi­tect of Oba­macare, say­ing: “This bill was writ­ten in a tor­tured way to make sure the CBO did not score the man­date as taxes. If CBO scored the man­date as taxes, the bill dies.”

The quote be­came fa­mous but was widely mis­un­der­stood; he was not re­fer­ring to the penalty ver­sus tax ques­tion, on which Chief Jus­tice John Roberts would later up­hold the law. The is­sue was whether the pay­ment for a manda­tory gov­ern­ment in­surance pro­gram should be scored as tax rev­enue – like So­cial Se­cu­rity or Medi­care pre­mi­ums – or con­sid­ered pri­vate sec­tor pay­ments. This is cru­cial be­cause a pro­gram scored as taxes and spend­ing is trans­par­ently a gov­ern­ment takeover, with po­ten­tially tril­lions of dol­lars shifted from the pri­vate sec­tor to gov­ern­ment.

There’s bad news for Joe Bi­den’s cur­rent plan. As Bi­den ex­plained: “I’d bring back the in­di­vid­ual man­date… and here’s the deal. We’re in a sit­u­a­tion where if you pro­vide an op­tion for any­body who in fact wants to buy into Medi­care for All, they can buy in.”

It’s hard to see how a man­date paired with a gov­ern­ment plan could be scored by CBO as any­thing but taxes and spend­ing.

The rel­e­vant CBO doc­u­ment is a re­port from May of 2009.

Bi­den’s Medi­care-for-All pub­lic op­tion would un­am­bigu­ously be scored as a gov­ern­ment pro­gram, even if he tried to dress it up as a non­profit. But what about the manda­tory pur­chase of pu­ta­tively pri­vate in­surance un­der the Bi­den scheme? Could tor­tured lan­guage ex­clude that from the CBO score? Prob­a­bly not this time.

The cen­tral frame­work of Oba­macare, an in­di­vid­ual man­date to buy a tightly reg­u­lated but no­tion­ally pri­vate in­surance prod­uct, was a close call for CBO. Gru­ber, Pelosi, and Obama got away with it based the ex­pec­ta­tion that there would be many dif­fer­ent com­pa­nies in the ex­changes (which in most of the coun­try has not oc­curred) and on the lack of a pub­lic op­tion.

Once Bi­den adds his pub­lic op­tion, the whole pro­gram clearly be­comes taxes and spend­ing, ex­pos­ing the mas­sive ex­pan­sion in the size of gov­ern­ment ex­pressly to the Amer­i­can peo­ple:

“In CBO’s view, a re­quire­ment that in­di­vid­u­als pur­chase health in­surance com­bined with tight federal con­straints on the mar­ket for such in­surance or a dom­i­nant role for a pub­lic plan would con­sti­tute a fun­da­men­tally gov­ern­men­tal sys­tem, re­flect­ing the ex­er­cise of the gov­ern­ment’s sov­er­eign power. In those sit­u­a­tions, pre­mi­ums ap­pear­ing in the bud­get – for a pub­lic plan or for in­surance pur­chased through ex­changes or in the pri­vate mar­ket – should be recorded as federal rev­enues.”

If CBO sticks to this stan­dard, Bi­den will lose the prin­ci­pal ad­van­tage of the pub­lic plan strat­egy – its abil­ity to cam­ou­flage from Amer­i­can vot­ers that it leads di­rectly to forc­ing ev­ery­one into a one-size-fits-all gov­ern­ment plan by cre­at­ing the il­lu­sion of al­low­ing a choice of pri­vate plans.

The “pub­lic op­tion” strat­egy for end­ing pri­vate in­surance is to set it up in a rigged com­pe­ti­tion with a gov­ern­men­trun plan that can ab­sorb losses in­def­i­nitely and can use the power of gov­ern­ment to dic­tate below mar­ket prices to doc­tors and hos­pi­tals – as Joe Bi­den dot com puts it: “the Bi­den pub­lic op­tion will re­duce costs for pa­tients by ne­go­ti­at­ing lower prices from hos­pi­tals and other health care providers.” Si­mul­ta­ne­ously, pri­vate plans would be sub­ject to reg­u­la­tions by the same gov­ern­ment that is com­pet­ing with them.

Amer­i­cans would have the il­lu­sion of be­ing able to keep their pri­vate in­surance for a while, but would all even­tu­ally end up in the sin­gle payer gov­ern­ment plan.

Some have said that makes the pub­lic op­tion a Tro­jan Horse for sin­gle payer, but Yale pro­fes­sor Ja­cob Hacker, the in­ven­tor of the plan, dis­puted that char­ac­ter­i­za­tion to a 2008 au­di­ence at the lib­eral Tides Foun­da­tion: “Some­one once said to me, ‘Well, this is a Tro­jan horse for sin­gle payer.’ I said, ‘Well, it’s not a Tro­jan horse, right? It’s just right there! I’m telling you!’”

Un­for­tu­nately for Bi­den, if the CBO fol­lows its own guide­lines on the is­sue, no amount of tor­tur­ing leg­isla­tive lan­guage will get him a score that con­ceals his in­ten­tion to have gov­ern­ment take con­trol of Amer­i­can health care.

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