Watching the GOP attack the stimulus bill as "spending, not stimulus," it's a pretty safe bet that they're going to unite en masse against new spending after the stimulus is added into the deficit number. Expect to hear the GOP say "trillion" with the frequency they used to say "9/11." This will have serious implications for health care. There's little doubt that health reform can save money in the long-term. But it also is likely to require up-front spending. For instance: Evidence showing that angioplasties really are overused could save billions of dollars. But to get that evidence, you're going to have to spend hundreds of millions running cardiovascular trials and gathering comparative treatment data. To invert the old cliche, you have to spend money to save money. This, of course, will come in for significant attack. But it also reminded me of something Max Baucus said at the AcademyHealth conference on Monday. Buried in his remarks was an interestingly specific fiscal measure for health reform. "Our intention," he said, "is to not spend any more than we are projected to spend over the next 10 years, but to do so covering all Americans." That 10-year window is important. Policies that cost money in year two might save money come year six. And the Congressional Budget Office will score them that way. For Baucus to say, up front, that his metric will be costs over a 10-year window, which ensures time for the initial investment to give way to the eventual savings, may prove very important as the debate grinds on.
