“You mean it should look even better?” asked host Jeffrey Brown. Tanden said yes. It would have been good if Brown had followed up and challenged Tanden about that old canard—savings from preventive care and information technology. Actually, as we’ve pointed out preventive care and health IT save very little, and in the end may end up costing money. But then the media has been reluctant to discuss any of that this past year, helping to perpetuate the notion of great savings over the decade.
Brown then tossed the ball back to Wilensky, and the conversation turned to other provisions that the president and the pols are banking on to produce more savings. Wilensky burst the bubble, explaining that the much ballyhooed programs, like bundled payments to doctors and other Medicare payment reforms, are simply pilots—attempts to figure out how to do things differently. “The history is,” she said, “promising pilots frequently don’t make it into law.”
She mentioned the excise tax on Cadillac health plans, which she said had been “emasculated,” and she cast doubt on the proposed Medicare payment advisory commission. “Basically, everything has been taken out of its purview,” she told Brown.
So as Wilensky tried to set the record straight and pierce the spin of the Obama folks, the rosy CBO predictions propelled reform closer to passage. In the end, the facts didn’t matter. Passage came down to raw politics. It always does.