WASHINGTON – The fate of White House and congressional efforts to overhaul the nation's health care system is likely to depend on the price tag, but there's no precise, reliable way to estimate the cost.
"This is very difficult to quantify," said Amitabh Chandra, a professor of public policy at Harvard University and a health care expert, speaking about proposed health care changes.
Such "structural shifts are incredibly hard to predict," added Gus Faucher, the director of macroeconomics at Moody's Economy.com.
When Congress returns to work Monday, health care is expected to dominate its agenda. By the end of the month, the House of Representatives hopes to vote on a plan, and two Senate committees anticipate finishing their versions.
The plans' future hinges on their projected costs. Estimates from the nonpartisan Congressional Budget Office guide Congress. The CBO pegged the 10-year price of a Senate health committee Democratic bill at $1 trillion and of a more comprehensive Senate Finance Committee measure at $1.6 trillion.
The Obama administration and lawmakers say that any health plan would be "paid for," meaning that it wouldn't increase the federal deficit. Obama and top Democrats say they can fund their plans with a combination of health care cost savings and as-yet-unspecified higher taxes.
Budget experts sound a warning: In a letter June 16 to senators, CBO director Douglas Elmendorf said, "Many of the specific changes that might ultimately prove most important cannot be foreseen today, and could be developed only over time through experimentation and learning."
The history of government estimates on spending, the economy and, in particular, health care gives some lawmakers pause.
The Bush administration was criticized widely after revelations that it deliberately had underestimated the cost of the new Medicare prescription-drug initiative as Congress considered the plan in 2003. Some Republicans had vowed not to back any bill with a price tag of more than $400 billion, so the administration said publicly that it would cost less than that. Later, Medicare officials conceded that they hid their internal estimate of $551 billion.
This time there's even more uncertainty about the numbers, because today's health care proposals are more complex. Among the unknowns:
• Behavior. Consumers and businesses often change their behavior immediately – and sometimes dramatically – in response to major policy changes.
• Technology. Will new medical devices and treatments be more expensive? Or will they detect potential disease early, and thus save patients money in the long run? "Who knew antibiotics would be discovered? Or there would be new treatments for HIV patients?" asked Chandra.
• Economy. If the recession deepens, would that require the government to insure more people? Few analysts predicted this recession's depth a year ago. The CBO projected about 1.2 percent growth in 2008; by the fourth quarter, the economy had declined at a 6.3 percent annual rate.
Call David Lightman, McClatchy Washington Bureau, (202) 383-6101.
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