CBO Director may help determine fate of health care

Several newspapers had articles on major players in health care reform. Douglas W. Elmendorf, director of the Congressional Budget Office, has "toiled for much of his career in the anonymous bowels of the nation's economic superstructure," the Washington Post reports.

But now, some lawmakers "think he holds the fate of public policy in his hands." After delivering a "skeptical analysis of a stimulus package intended to rescue the U.S. economy" and forecasting "bigger-than-expected losses from a $700 billion bailout of the U.S. financial system, Elmendorf now "faces the toughest task of his brief tenure: attaching a price to a monumental overhaul of the nation's health-care system." Sen. Max Baucus, D-Mont., has "publicly lectured Elmendorf, saying he has a moral duty to be 'creative' and deliver the favorable budget estimates 'we have to have' to win broad support." But Elmendorf says "his office will offer an objective analysis, 'without regard to the political consequences.'" Elmendorf told the Post that his office would provide the information, but the decision is in the hands of Congress. "CBO is not going to make or break health-care reform," he says.

A graduate of Princeton and Harvard, Elmendorf was also "part of a team of CBO analysts who in 1994 concluded that President Bill Clinton's plan to overhaul the health system would cost far more than advertised and vastly expand the federal government," helping to kill the legislation. Elmendorf's opinion is "most eagerly waited" on the question of "whether changes in the delivery of health care -- more prevention, better information, closer coordination among doctors -- can wring some of the waste out of a system expected to consume nearly $2.3 trillion this year." So far, "the CBO has proven unwilling to assume big savings from popular reforms, such as computerizing medical records and studying the comparative effectiveness of various treatments." Elmendorf "acknowledged that health reform is especially challenging." It requires the CBO to "make decisions based on scant or preliminary evidence" without caving to partisan pressure. It is no coincidence that "the agency's unofficial mascot is a skunk, a furry toy passed from director to director as a reminder to deliver the truth, even when it is as welcome as a skunk at a picnic" (Montgomery, 6/11).

Meanwhile, other major players are also emerging in the health care debates. Sen. Ron Wyden, D-Ore., met with President Barack Obama yesterday to talk about health care, Roll Call reports. "The discussion with Wyden, whose health plan has the support of some Republicans, came on a day when Obama sought to emphasize his commitment to trying to get a bipartisan bill." The White House has not provided details of the conversation (Koffler, 6/10).

The ranking member of the Senate Finance Committee, Sen. Chuck Grassley, R-Iowa, met with President Obama "on ways to resolve 'sticking points'" in a health care overhaul, the Des Moines Register reports. "There's a heck of a lot of agreement but the agreements are on some noncontroversial things," Grassley said. "But there's three or four things out there that are very controversial," he continued. Grassley also "said there is still no consensus on major issues, such as how to pay for it when the expense could top $1.5 trillion over the next decade; whether private companies should be required to kick in money to the federal Treasury if they choose to drop health plans for their own workers, and whether a board of health should make health care decisions rather than Congress (Jacobs, 6/11).