Posted on March 2, 2009

Sen. Baucus wants CBO to be "creative"


Hearing: Scoring Health Care Reform: CBO’s Budget Options

United States Senate Committee on Finance
February 25, 2009

Closing comments

Sen. Max Baucus, Chairman: Thank you very much, Dr. Elmendorf. We have a huge problem, haven’t we? This is the most difficult public policy undertaking I’ve experienced in my Senate life here. I’ve been here thirty years, and nothing is as difficult as this. Nothing is as important as this, and I cannot think of anything that depends so much on CBO, especially at a time we’re in new territory. We’re not in the old situation where Sen. Grassley once said whatever CBO says is God, you’re God. My judgement, you’re not God.

Douglas Elmendorf, CBO Director: Correct

Sen. Baucus: My judgement is that you got the whole new era - you might be Moses, but not God - but you got the whole new era… where as I said earlier it’s not too much of an overstatement to say CBO can make or break health care reform, and I mean that because we got to go by your numbers…

Dr. Elmendorf: Senator, may I respectfully disagree that…

Sen. Baucus: I do believe that there are several different intellectually honest pathways to get from here to there. It’s not just one automatic, and so it needs - you got to be ever more creative to find intellectually honest pathways to get the savings we have to have - practically and both politically - to get health care reform.

Dr. Elmendorf: Senator, I would like to just respectfully disagree with the make or break role that you have assigned to us. We will do our very best to provide you and all of the members of this committee and the rest of the members of the Congress with the technical information that you need, the best estimates that the knowledge of the world can provide about the effects of alternative policies, but, as you understand, the hard decisions will be yours.

Sen. Baucus: No, that’s incorrect. The hard decisions will be all ours, both of us, you and me. You can’t pass the buck. The hard decisions are here, and the hard decisions are yours and the hard decisions are all of us in this country in trying to make this work. Meeting’s adjourned.

Dr. Elmendorf: Thank you, Senator

Video of hearing - click link of 2/25/09:


By Don McCanne, MD

In this closing exchange, Sen. Max Baucus seems to be annoyed with Douglas Elmendorf, Director of the Congressional Budget Office. What is the background here?

Sen. Baucus is determined to lead the way to comprehensive health care reform. His model is basically the Hacker/Obama/Kennedy/Daschle/Massachusetts/Commonwealth model which is based on expanding the use of regulated private health plans, while continuing to expand existing public programs.

To help Congress with its efforts on reform, CBO recently released two volumes on 1) issues on analyzing health insurance proposals, and 2) budget options for health care (both available at the CBO website It is quite clear, based on these two reports and on the innumerable analyses in the health policy literature, that Baucus’s model would be scored by the CBO as outrageously expensive while falling far short on many of the important goals for health care reform.

The CBO is noted for its impartiality in providing Congress with intellectually honest evaluations of various Congressional proposals. From Sen. Baucus’s comments, it’s obvious that this constitutes a major barrier to his ambitions to enact reform along the lines of his model. Rather than an arm’s-length analysis, Sen. Baucus is demanding that Dr. Elmendorf shift from the role of an impartial analyst to the role of a policymaker by becoming “creative,” making the “hard decisions,” to “find intellectually honest pathways to get the savings we have to have.”

We can understand Sen. Baucus’s frustration in his inability to obtain a favorable analysis of his highly flawed, “wish-they-would-work” policies. But we can fault him for demanding that Dr. Elmendorf compromise his professional integrity by participating in the policy decisions over a fundamentally flawed framework of reform, and then applying to the final product his personal stamp of endorsement. That is not and must never be the role of the CBO Director.

This also partially explains why Sen. Baucus is becoming ever more strident in his demand that single payer be totally excluded from the dialogue on reform. Innumerable analyses, including some by the CBO, have shown that the single payer model actually would achieve our goal of affordable health care for everyone. Objective, side-by-side CBO analyses would destroy any chance of convincing Congress to enact Sen. Baucus’s model.

Since reform should be based on the best data available, isn’t such an analysis exactly what we should have right now? If Sen. Baucus is sincere in wanting reform that works for all of us, he should be the first one to request that CBO do that study.

DrSteveB also covers this well in his Daily Kos blog today: