Health care issues: Calculating the price tag

A look at key issues in the health care debate:

THE ISSUE: Is the Congressional Budget Office doing an accurate job of calculating how much the health care overhaul will cost?

THE POLITICS: Democrats pushing for overhaul of the nation’s health care system face a dilemma — they want to cover as many people as generously as possible, while limiting the cost to deflect Republican accusations that they are addicted to spending and tax increases. That makes every dollar count. Despite the nonpartisan budget office’s solid reputation for making objective, fair calculations, Democrats say its bean counters are being far too conservative in crediting them with finding ways to save money. Such criticisms are common from both parties when they get cost estimates they don’t like from the budget office.

WHAT IT MEANS: The budget office has been reluctant to credit dramatic savings to groundbreaking proposals like penalizing hospitals that readmit many patients or reshaping the way Medicare reimburses doctors and hospitals for treatments. With President Barack Obama promising to sign legislation only if it doesn’t increase the federal deficit, the office’s calculations have made reaching that goal tougher. Also damaging were July comments by budget office director Douglas Elemendorf, who said that rather than forcing the health care spending trajectory downward, “the curve is being raised.”

— Alan Fram