IS THIS ALL ABOUT CBO?

There's an emergent argument that the real import of today's letter is that it serves as a club against the Congressional Budget Office. As Igor Volsky writes:

The signers — the Advanced Medical Technology Association (AdvaMed), America’s Health Insurance Plans (AHIP), the American Hospital Association (AHA), the American Medical Association (AMA) and Pharmaceutical Manufacturers of America (PhRMA), among others — hope to contain costs by implementing “aggressive efforts to prevent obesity, coordinate care, manage chronic illnesses and curtail unnecessary tests and procedures; by standardizing insurance claim forms; and by increasing the use of information technology, like electronic medical records.”

The industry is suggesting that these cost containment measures — which don’t score too well with the Congressional Budget Office — would in fact yield cost savings and help finance health reform. The letter blunts conservative critics who argue that health reform is unsustainable or too expensive, and it also takes on the CBO, whose models are likely under-scoring the savings from reforms.

It's true that legislators are very concerned that the Congressional Budget Office won't score likely savings. That will mean the bill's total price tag is higher and the legislation is harder to pay for. But this letter doesn't obviate that problem. It doesn't even change it. The issue isn't that a CBO price tag is credible, and so you need another credible price tag if you want to argue against it. It's that the CBO number is one used by the budget committees, and so if health care is going to pass under pay-go rules -- and my understanding is that it will -- then you have to find revenues that match whatever CBO says the cost is. The revenues can't just match what the industry says the cost is. For much more on the importance of CBO and the price tag it selects, read this piece.

The other option here is something called "directed scoring." Under this scenario, Congress would essentially order the CBO to score health reform in a certain way. I know that some quarters are discussing this possibility, but I don't think most people believe you can get very far with it. More on this later.