T-Word Looms Large In Health Care Cost Debate

Everybody knew that a complete overhaul of the nation's health care system was going to be an expensive undertaking. But just how expensive started to become a little more clear this week when the Congressional Budget Office slapped a preliminary price tag of $1 trillion over 10 years on an incomplete version of one Senate bill, and $1.6 trillion on a competing measure. And the cost estimates have sent at least one key Senate committee back to the drawing board.

Despite reassurances by President Obama and Democratic leaders that all new spending would be fully offset by other spending cuts or tax increases, Republicans immediately jumped on the T-word.

"Is a $1 trillion government takeover of health care really worth it if it leaves at least 36 million Americans uninsured and forces at least 23 million Americans off their current plans?" asked House Minority Leader John Boehner, ignoring the fact that the numbers provided by the CBO did not include key provisions that would likely have significantly boosted the number of people newly covered by health insurance.

Sen. Johnny Isakson (R-GA) used a more colorful way to illustrate just how much a trillion is.

"If you converted dollars to seconds, and you said how many years will it take for a trillion seconds to pass, it's 317,097 years, 11 months and two days," he said at a meeting of the Senate Health, Education, Labor and Pensions Committee.

Seeking Bipartisan Support

Meanwhile, Senate Finance Committee Chairman Max Baucus (D-MT) said the tentative $1.6 trillion attached to his bill by the CBO is causing him to reconsider many of its provisions. Baucus, perhaps more than any of the other Democratic committee chairs in the House and Senate, is hoping for a bill that can win bipartisan support.

Baucus said he's planning to come up with a reworked bill that "will be under a trillion [dollars], probably just under a trillion. And it will be fully paid for." He said anything over that amount "starts to run into some natural resistance" from other senators, "which causes problems we don't need to have."

But while Baucus may be reading his colleagues right, his colleagues may be misreading public opinion polls. Andrew Kohut of the Pew Research Center for the People and the Press says that while the public is worried about excess government spending, it's more worried about fixing what ails health care.

"The public is going to worry about the government spending lots of money even on things that it very desperately wants," Kohut says. "But when we asked people specifically, as we did a month ago, or two months ago, which is more important, fixing health care or controlling the budget deficit, a pretty wide majority say fixing health care."

'A Drop In The Bucket'

Jacob Hacker, the political scientist from the University of California, Berkeley who designed the original plan on which most of the congressional Democrats' bills are based, says that imposing an arbitrary $1 trillion limit could turn out to do more harm than good.

"It's going to take money upfront; it's going to take a lot of money," says Hacker, particularly to get a new system up and running. "But if we don't spend the money now, we're going to be unable to control costs, unable to provide secure coverage to Americans in the future."

And while the idea of a trillion dollars might be frightening to think about, Hacker says, "it's a drop in the bucket in many ways" compared to how much the nation currently spends on health care — roughly $2.2 trillion per year and growing. In fact, he says, "the difference between $1 trillion and $1.5 trillion over 10 years is probably about a half of a percent of difference in growth in health spending over those years."

Still, however you slice it, a trillion is a really, really big number, "even in Washington," as President Obama put it in his speech to the American Medical Association on Monday.

Or, as children's math and science author David Schwartz describes it: "A trillion dollars would be enough to buy a thousand boxes of Girl Scout cookies for every person in the United States, if that's how you wanted to use the money."

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