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ON THE IMPOSSIBILITY OF QUICK MAJOR REFORM. Since we're having a big debate about health care reform -- with one side (Ezra and Bob) calling for bold sweeping proposals, and another side (Paul), suggesting that any change, even if small (and actually counterproductive in the short term), is better than nothing, I feel compelled to throw a dose of cold water on the proceedings in the form of a reminder that this Democratic Congress adopted strict pay-as-you-go (PAYGO) rules on January 5th:
Under the new provisions, the House will for the first time in years be required to pay for any proposal to cut taxes or increase spending on the most expensive federal programs by raising taxes or cutting spending elsewhere. And lawmakers will be required to disclose the sponsors of earmarks, which are attached in virtual secrecy to legislation to direct money to favored interests or home-district projects.An aide to one of the newly powerful Democratic committeemen told me over the weekend that she's pretty certain that for the next two years there will consequently be no major new health insurance programs or major reforms. Not only would any new proposals have to be budget-neutral under PAYGO, but they would have to be budget-neutral within the budget for the specific committee that was drafting the bill, as each committee is responsible under PAYGO for balancing its own bills. Rather than new health care programs being enacted, she explained, there will likely in fact be a belt-tightening. Even the existing children's health program, which is up for renewal, will be a budget battle, she predicted, because it's flawed and will end up costing more than it currently does, which means something else will have to get cut somewhere.Further, she said, presidential candidates who are in Congress all know this, and this should be taken into account when evaluating their health care proposals, both for this Congress and for future ones.
--Garance Franke-Ruta
