Maybe if Republicans had put forth responsible reforms when they had a majority in both houses of Congress, we wouldn't have gotten to this point. This legislation may send the masses running back to the Republicans, but my memory isn't that short.

What did the Republicans do about healthcare from 2000-2006 when they had both branches of Congress and the White House? NOTHING! Just approved everything W sent your way. The collapse of the economy began under your watch, dont act blameless.

You guys dont care about serving the greater good, its about saving your own jobs, and getting re-elected.

"Americans...can’t afford"
"expensive new entitlement"
"$2.6 trillion in new spending"
"There’s no free lunch."
"the bottom line is we cannot afford this new entitlement."
"We have bills that as a nation we can’t pay as it is."
"we do not serve the greater good if our actions bankrupt our nation."

The tax cuts, military spending increases, and enactment of Medicare Part D from 2001 to 2009 put a $650 billion/year hole in our deficit, whereas this bill will decrease the deficit by an average of $10 billion/year over the first decade and $120 billion/year over the next decade. The hypocrisy here is astounding.

Actually, John, it won't. The Medicare doc fix was excluded from the bill and will be voted on separately. It erases any deficit reduction.

http://www.cato-at-liberty.org/2010/03/21/former-cbo-director-obamacare-would-add-562-billion-to-federal-deficits/

http://www.cato-at-liberty.org/2010/03/19/cbo-obamacare-would-increase-deficits-by-59-billion/

What does that have to do with this bill? The deficiency in Medicare reimbursement rates has been around since long before this reform bill was under consideration and had to be fixed regardless of whether this bill was passed or not.

Do I really need to explain that to you?

It was a political move. The bill passed last night dealt with Medicare as much as overall regulation of the health insurance industry. It's clear that leaders wanted to separate reimbursements so not to add to the cost of the the president's bill, which would have resulted in deficits.

And if you really believe that the bill, even without the doc fix, was going to result in deficit reduction, I have a bridge to sell you.

http://www.theatlantic.com/business/archive/2010/03/first-thoughts-on-the-cbo-score/37720/

"It's clear that leaders wanted to separate reimbursements so not to add to the cost of the the president's bill, which would have resulted in deficits."

Yes, but you're not explaining to me why this indicates anything negative about the bill itself. If this reimbursement increase had to happen anyway, regardless of whether the HCR bill was passed or not, doesn't that still mean that the HCR bill decreases the deficit?

The CBO has a good track record of predicting the impact of health care reform bills. In fact, it drastically over-estimated how much Medicare Part D would cost and drastically under-estimated how much money the 1998 Balanced Budget Act would save within Medicare.

This bill is the biggest long-term deficit reduction effort ever to pass Congress, and the "fiscally conservative" Republicans fought it every step of the way.

The CBO says their estimate is subject to uncertainty. In fact, the CBO's estimate relies mostly budgetary gimmicks.

While you're right about Medicare Part D, the lower than expected result of that program is due to its unpopularity more than anything else. Unlike what was passed on Sunday, it's optional. Unlike Medicare Part D, which deals with a segment of society, Obama's bill affects everyone. In reality, there are few examples of estimates that come in under the expected cost.

Even if the CBO's estimate were correct, which it's not, it has also predicted that budget deficits over the next 10 years will be around $9.8 trillion. So, please explain to me why we should be so giddy about $140 billion in deficit reduction, which really doesn't exist?

You have to take into account the massive costs of compliance to private business, which the CBO does not score.

The bill passed Sunday night dealt with Medicare, so why not include the doc fix? And it was included in earlier versions of the bill, according to the AP.

Democrats didn't included it because it made the bill more expensive and resulted in budget deficits. This would have been unattractive to members and would have killed the bill.

Nothing I say is going to satisfy you because you're just going to come back with another talking point.

Of course the CBO's estimate is subject to a great deal of uncertainty. Nobody really knows what will or won't work to control health care costs. But, except for perhaps tort reform, the public option, or single-payer, the Democrats threw pretty much every idea people had into this bill.

I'm not a talking points drone, but at the same time you aren't answering my question: How does the Medicare reimbursement problem indicate anything negative about the rest of the bill? Are you just trying to say that it doesn't cut the deficit enough? That's certainly something I could agree with. This isn't the best bill in the world by any stretch of the imagination. But it's a huge improvement over the current system, which simply leaves behind the 35 million people out there without insurance.

And although this goes a long way towards reducing long-term deficits- which are driven mainly by cost increases in Medicare and Medicaid, you're right that the short term problems we have are huge, and this bill doesn't do much to address that.

The best things we could do to reduce the short-term deficit are to improve the economy, reduce our military commitments, and raise tax revenues by getting rid of regressive, market-distorting tax deductions.

Of course the CBO's estimate is subject to a great deal of uncertainty.

Does that not put deficit reduction in up in the air? How is what you said about deficit reduction not a talking point if you are now admitting that the CBO acknowledges those estimates to be arbitrary.

How does the Medicare reimbursement problem indicate anything negative about the rest of the bill? Are you just trying to say that it doesn't cut the deficit enough?

I'm saying that it doesn't cut the deficit at all.

[I]t's a huge improvement over the current system, which simply leaves behind the 35 million people out there without insurance.

That number is not entirely accurate. Most of the "uninsured" are so because they make a choice to be uninsured.

http://www.factcheck.org/2009/06/the-real-uninsured/

And although this goes a long way towards reducing long-term deficits- which are driven mainly by cost increases in Medicare and Medicaid

This bill does absolutely nothing to address the Medicare's $30+ trillion in unfunded liabilities. In fact, it creates a new entitlement through subsidies for health insurance (corporatism) and expands Medicaid.

The best things we could do to reduce the short-term deficit are to improve the economy, reduce our military commitments, and raise tax revenues by getting rid of regressive, market-distorting tax deductions.

I agree that we should reduce our military commitments, this would include getting out of Iraq and Afghanistan. I would also agree in eliminating tax deductions. However, I believe that we should be cutting spending and enacting broad-based tax cuts for all Americans.

Does that not put deficit reduction in up in the air?

This bill does absolutely nothing to address the Medicare's $30+ trillion in unfunded liabilities.

As I said before, the real deficit-reduction benefit of this bill is in the long-term. According to the CBO, this bill will indeed extend the solvency of Medicare by 10 years- no small feat. The CBO's estimates aren't "arbitrary"- they're uncertain. Maybe you're not familiar with the distinction. Uncertainty means they could also be under-estimating how much it will reduce the deficit.

That number is not entirely accurate.

The 35 million number has a lot of stipulations that goes with it, but factcheck certainly doesn't say that "Most of the "uninsured" are so because they make a choice to be uninsured." unless you're using an exceptionally broad definition of "choice".

I'm saying that it doesn't cut the deficit at all.

You're still not telling me why the Medicare reimbursement fix's negative deficit score diminishes the HCR bill's positive score. The two are unrelated. It's not as if we're shifting some unseen cost of the HCR bill outside of the CBO score. That cost was there before HCR passed and would still be there if HCR had not passed.

You're still not telling me why the Medicare reimbursement fix's negative deficit score diminishes the HCR bill's positive score.

I've explained this. The doc fix cancels out the deficit reduction in the CBO estimate.

Perhaps I'm not being clear.

If you combined the military budget into the HCR bill, that would cancel out its deficit reduction too. But would it then make sense to say that the HCR bill doesn't reduce the deficit? No- because the HCR bill doesn't have any effect on the military budget.

Before the HCR bill passed, the doc fix needed to be fixed. Afterwards, the doc fix still needs to be fixed. The doc fix is not caused by, related to, or made worse by the HCR bill.

As noted by the AP in an article I linked yesterday, the Medicare doc fix and the health care bill were originally together. Democratic leadership separated them to make the bill's cost go down.

You don't seem to understand that or want to accept that fact.

The AP also shot one of your claims from yesterday down:

Democrats say the bill — even as it cuts Medicare to pay for expanded coverage for working families — will add at least nine years of solvency to the program's giant hospital insurance trust fund, now projected to be exhausted in 2017.

Technically that's true — but only on paper.

Savings from the Medicare cuts will be invested in government IOUs, like any other trust fund surplus. The special Treasury securities count as an asset on Medicare's books — making the program's precarious financial situation seem more reassuring. But the government will spend the actual money. And when time comes for Medicare to redeem the IOUs, lawmakers will have to scramble to come up with the cash.

The key point is that the Medicare savings will be received by the government only once, the Congressional Budget Office said, "so they cannot be set aside to pay for future Medicare spending and, at the same time, pay for current spending ... on other programs."

You don't seem to understand that or want to accept that fact.

I understand and accept this fact. But it doesn't change anything. I don't know how much more plainly I can make this argument...

Because the reimbursement fix had to be done regardless of the HCR bill, the real question is whether the HCR bill itself increases or reduces the deficit. So let's step through two alternative histories:

1) HCR does not pass, Doc fix still has to pass. Result = $208 billion deficit.
2) HCR does pass, Doc fix still has to pass. Result = $70 billion deficit.

Total impact of HCR passing = $138 billion deficit decrease.

[T]he real question is whether the HCR bill itself increases or reduces the deficit.

That is an estimate based completely on budgetary gimmicks. You cannot honestly tell me that it is going to reduce the deficit and expect me to take you seriously.

http://www.nytimes.com/2010/03/21/opinion/21holtz-eakin.html

So you concede the point about the doc fix?

Not at all, because it defies logic to believe that it will reduce the deficit and even if it did, they would be erased by the doc fix.

I feel like you haven't read anything I've written.

Regardless about whether you believe the HCR bill will reduce or increase the deficit, the doc fix is irrelevant. It has to be done regardless of whether HCR had passed or not.

It's as nonsensical as saying that HCR won't reduce the deficit because "even if it did, it would be erased by the planned Bush tax cut extension" or "even if it did, it would be erased by this year's military supplemental spending bill".

The two are unrelated. Sure, they were initially going to be passed in the same bill, but that doesn't mean that passing HCR in any way affects how much the doc fix will cost.

I'm reading, but you don't want to acknowledge fact. You say you do, but I don't believe you.

You cannot possibly say they are unrelated and the doc fix doesn't have to be done. Though you may personally see it as having to be done.

Congress is eventually going to have to make some tough choices and cut payouts, considering the unfunded liabilities of Medicare.

I've never claimed that the health care bill would have any sway of the price of the doc fix. I said that the doc fix will cancel out what ever savings the CBO estimates we'd see.

We're getting nowhere. I'm sure we both have better things to do.