The Cato Institute and the Heritage Foundation ought to be happy. The coverage of the House budget resolution more or less includes their talking points about how "spending is the problem" with the federal budget. What's more, these ideas are not attributed; they're just presented as facts that the reporters decided, for an unnamed reason, to add to these stories.

THe New York Times:

Indeed, total government spending has climbed far faster under Mr. Bush than it did under President Bill Clinton, while tax revenue has climbed far more slowly. All told, federal debt has grown by almost $4 trillion since Mr. Bush took office.

Given this uncertainty, Democrats argue their more incremental approach is the better course to restore more discipline. But they have made little attempt to address the rising costs of benefit programs, and much rests on Congress's ability to stay focused on deficit reduction.

Neither of these passages seem to make factual errors. Yes, spending has exceeded revenues- that's called a running a deficit (Someone explain to me how else you run a deficit, I'm curious). And no, the Democrats haven't made an attempt to address "benefit program" costs, which I'm assuming is a clever new way to lump together the problems in Medicare and Medicaid with Social Security and perhaps all other domestic aid programs. Why aren't the reporters more specific about what type of spending they're talking about?

And what exactly rests on Congress's ability to reduce the deficit? Cutting "benefit programs," you know, isn't the only way to reduce the deficit, though that's pretty much how it's framed here.

These reporters are doing Cato and Heritage's work for them. Who do these reporters work for- the public or radically conservative policy shops?

Tom Paine has an odd post up about health care costs. The argument, I think, is that we need to be careful containing health care costs because the industry generates many jobs, and health care costs are high, generally, because of demand.

The predatory lending industry provides jobs, too. It's costs are quite high, yet there is demand for its products. But that doesn't mean we shouldn't cut those costs, right?

This passage bugged me, too:

The problem for consumers was that the industry kept growing, adding layers of administration, adding job classifications and increasingly expensive equipment and treatments. In its success, health care extended life expectancy, but that increased lifespan also added hugely to medical costs: half the health care dollars an individual expends occur in the last six months of his or her life—much of that life artificially maintained.

You'd think these people would be paying for effective procedures that extend life, but do they? What evidence does the author have that they do?

It seems quite possible to me that health care at this stage could be remarkably ineffective. People don't know what they're paying for, and health care providers have an incentive to offer ineffective products and procedures if they're paid to do it. In fact, that's what health care researchers often say happens.

Jesse Jackson has a good editorial on the African American children being left behind by federal policy. One passage I thought needed playing up:

We need longer school years and far better teachers, and teacher education. We need less discrimination in spending, in discipline, in advanced placement. Some of this costs money. But, Williams says, we're not spending the money we currently have well. For example, our broken health-care system is killing school budgets. Health-care costs are going up 10 to 15 percent a year, far outstripping normal increases in public funding.

The most persuasive reason to address the long-term budget imbalance, which is being driven by rising health care costs, is not that we should be afraid of what's going to happen in 2050. It's what these rising costs are doing to ordinary people right now -both through crowded-out social spending and squeezed personal finances.

The only way to begin getting at the root cause of both these issues -the governmental and the personal- is to reform the health care system.

Reform is both possible and inevitable. All other industrialized countries have successfully contained health care costs at the same time that they've universalized access and maintained quality. Demand for a better health care system will only get stronger, if the predictions are right that health care is only going to get more expensive. And at a Center for American Progress health care forum last weekend, all of the Democratic presidential candidates went on record promising to deliver universal health care insurance and lower costs if they get elected.

All easier said than done, of course. Addressing health care and long-term budget issues will require political courage, sacrifice and persistence. Budget advocates should show some of this resolve by calling for fundamental change, not tax and budget tweaks that give no immediate benefit to a public that's suffering under a broken health care system.

Dean Baker makes an interesting point on how the debate over the long-term budget imbalance is very one-sided. There are many experts who think that the problem really is that the health care system is broken and that the solution is to fix it, but they rarely get public attention.

What could people who want to promote this view do? I think we need to draw up a plan to fix the health care system with an eye towards cost-containment. That'd give us a) something new to say and b) a policy position that's more appealing than the opposition's (which is to basically to shift costs by cutting programs and raising taxes- not a hard package to beat).

The only thing the David Walker's of the world have to sell is fear. We should try selling some hope.

The committee rejected a number of amendments, including one from Sen. Jim Bunning (R-KY) to create a 60-vote point of order against any budget resolution that failed to reach balance, excluding Social Security funds, in five years. By excluding Social Security funds, the deficit would be significantly higher than the current level and the budget would be that much more difficult to balance. Funny that Bunning did not advocate for using this larger deficit figure when the Republicans controled the Senate.

The panel also rejected an amendment by Sen. John Cornyn (R-TX) to instruct the Finance Committee to find $33.8 billion in savings over five years, with the intent that the reductions come from putting in place a proposal by President Bush to reduce reimbursements to Medicare providers.

Quick comment on Robert Pear's article yesterday on Medicaid- a must-read, by the way- that demonstrated that falling caseloads may be in part due to new "proof of citizenship" requirements.

Medicaid costs, too, have been going down. Supposing these two trends are related, and it would seem they are, citizenship documentation seems nothing more than a high-handed way to cut budgets and deny people (the vast majority of whom are citizens) health care. Let's remember this if the President ever decides to boast of the cost-containment his policies have achieved.

The supplemental also would ensure that individuals applying for Medicaid have the same "reasonable time period" to show citizenship documents as they would in applying for other programs such as food stamps. It would clarify that children born in U.S. hospitals meet Medicaid's citizenship requirement, regardless of the immigration status of the parent.

Nathan Newman at TPM Cafe has a good post on health care costs.

His most topical point is that the Bush health care tax package, which is ostensibly intended to reduce health care costs through financial incentives for health care consumers, is hopelessly misguided and beyond repair. Most health care spending occurs among a small minority of spenders who receive very expensive, intensive care that they likely see as not being optional. Incentives one way or the other probably won't make much of a difference.

And people getting expensive treatment probably don't have time to shop around for the best deal. We're most likely dealing with sick, frightened people who don't have much time to spare. And would they recognize a deal when they saw one? Probably only a highly trained physician would- what non physicians know enough about health care to make that call? So giving health care consumers the incentive to shop around will probably not increase competition among health care providers. No savings there, either.

Increasing deductibles would most likely not impact the cost of the treatment that very sick people get. Informed, streamlined management of the health care delivery system that puts the patient before profits might, though. After all, it's worked in every other industrialized country- all of which don't really have long-term health care spending problems like we do.

GAO Chief David Walker showed up on 60 Minutes yesterday. Dean Baker has a nice takedown of what he said.

I accuse him of three more errors against entitlements and the long-term fiscal imbalance.

First, he limits options for policy solutions:

So where's that money going to come from?

"Well it's gonna come from additional taxes, or it's gonna come from restructuring these promises, or it's gonna come from cutting other spending," Walker says.

What about reforming the private health care system- the source of the problem?

Second, he distorts the opposition's beliefs:

The only dissenters seem to be a small minority of economists who believe either that the U.S. can grow its way out of the problem, or that Walker is over-stating it.....

"Unfortunately they don't get it. I don't know anybody who has done their homework, has researched history, and who's good at math who would tell you that we can grow our way out of this problem," Walker replies.

If Walker and CBS were good at reading, they would know that some people think the solution is to overhaul the health care system. Even CBO is starting to think that way. BNA ($) reported this morning that it's forming an advisory panel to study how to control costs in the private sector to contol costs in the public sector.

And third, he doesn't know what he's talking about.

Of course we can't grow our way out of an inefficient health care system; they have nothing to do with each other! Even if the economy was big enough to pay for our bloated health care system, it would still incredibly wasteful and inhumane. And you can't make it more efficient by cutting benefits or raising taxes. That just shifts costs around; it does next to nothing to control health care prices. CBO Director Peter Orszag said as much in today's BNA:

Reducing spending in Medicare and Medicaid likely will only shift costs to other parts of the health care system, doing little to sustain the overall health care system or those federal health care programs, he added.

Director Orszag seems like he gets it- I look forward to seeing what options his team comes up with. How about Walker keeps quiet until then?

Things are moving forward on a plan to create a panel (CQ, $) of legislators who'd come up with proposals to curb long-term fiscal problems.

If created, the commission will no doubt propose legislative packages of "tough choices," a euphemism for painful legislation that'll cut benefits here and raise taxes there, with the intention of reducing the long-term budget imbalance, but not producing any tangible benefit for the public.

Now, who knows? Maybe on balance they'll be progressive packages. But why should the public suffer AT ALL for the greatest failure in domestic politics this last half-century- the failure to create an efficient, universal health care system?

It's our inhumane, wasteful, for-profit health care system that's mainly driving up the long-term budget imbalance. It's Congress's responsibility to make our system better, but they haven't.

The public never demanded health care it couldn't afford. It never refused to pay for Medicare or Medicaid. Budget problems in these programs occurred as a result of Congressional dysfunction and inaction. The government has let their costs get out of control by not reforming the system.

It's Congress's fault for letting us rack up huge budget imbalances. The public should not have to pay for Congress's mistakes.

Instead of just cutting benefits and raising taxes, Congress ought to do its job and make our health care system work better and cheaper for everyone.

Here's an interesting study of Sen. Ron Wyden's plan to provide health care insurance for all Americans. It estimates that the plan would slow the growth of health care costs by nearly 1 percent, a reduction in total health care spending (public and private) of about $1.5 trillion over ten years.

You can agree or disagree with Wyden's plan (I think it relies too much on private insurers and doesn't go far enough to control costs). What's inarguable is that providing more health insurance would control costs in a moral and effective way.