Health Reform By The Numbers

I’m a numbers person. You can talk all you want about effects of health reform. But I won’t be impressed until I see the numbers, provided, of course, the numbers fit my point of view. When politicians start throwing around numbers, it's generally about budgets, and how to fix them to match them to fit your view of the world.

Democrats say they are going to sell their reform bill by talking about those 31million that will now be covered and those 5 million, or whatever the real number is, that will no longer be denied coverage for pre-existing conditions or expensive dieases. This is an important selling point since 133 million Americans are estimated to have chronic disease.

Republicans will seek to discredit health reform bills by saying the bills will cost $2.3 trillion, not $879 billion, taxes will start in 2010 but benefits don’t kick in until 2015, true costs will explode after 2019, and bureaucrats not doctors will be practicing medicine.

The true numbers, as we know them now, before the reconciliation (that’s the term being used to describe the divorce settlement between liberal and conservation Democrats). It's worth taking a numeric stab about what how the numbers might shake out.

According to the Congressional Budget Office, the budget numbers for the years 2010 to 2019, are,

• $395 billion in federal spending to expand the number of people covered by Medicaid and CHIP, insurance programs for the poor. Comment: The feds say these numbers are modest considering benefits to the uninsured ; the states say the numbers are crushing and unsustainable.

• $436 billion in federal spending to pay for health-insurance exchanges that be used by people who don’t get health insurance through work. Most of that money will come as subsidies for insurance premiums for people earning up to four times the poverty level. Comment: Cynics say some families making $96,000 would qualify, depending on how you parse the numbers.

• $398 billion in new taxes. That includes the tax on high-value health-insurance plans, new fees on health insurers and drug and device makers, higher payroll taxes for high earners, and indirect taxes on consumers and the middle class as you pass effects of new high taxes onto new premium costs. Comment: Do the effects of these higher taxes and higher costs leave anyone out?

• $483 billion in cuts to projected spending for Medicare and other programs. This includes reductions in projected costs for privately administered Medicare Advantage programs and a new formula likely to lower annual increases in payments to hospitals. Comment: These are numbers likely never to materialize if the history of Medicare is any guide.

• 31 million additional people would have health insurance by 2019 because of the bill and 23 million people in this country would still be uninsured. Comment: Don’t worry about the 23 million. We’ll cover them later.

So there you have it – a rundown on the numbers. I trust I have helped you understand the effect of health reform through this numbers exercise. Health reform is not rocket science. It is numerical. It is not numerological – a system of occultism based on how many people might abuse, overuse, or be confused by what lies ahead. Health reform is based on hard numbers, subject to two by ifs - human responses to budget incentives and shifts in the political landscape.