We've been stuck in what would probably count as a serious snowstorm even in places like Pittsburgh and Cleveland (though not Buffalo), so I've had a chance to read a good bit of the CBO's compendium of health care proposals and their effect on the federal budget. The good news is that a number of fairly standard issue proposals—a pay-or-play system, tweaking the rules on Medicare Advantage plans to reduce overpayments—have a fairly small impact on the budget. And of course some are even revenue positive. The bad news is that most of these options barely put a dent in the number of uninsured individuals. Take pay-or-play. As I read it, the CBO estimates that pay-or-play would reduce the ranks of the uninsured by 330,000. And that's with a lower bar for what qualifies as insurance than the Massachusetts plan, plus a higher penalty for not offering insurance; in other words, the CBO is analysing something that's going to have more of an effect than anything you would want to pass.
On the plus side, the government makes some money off the pay-or-play system, which might be enough to pay for insurance for more than another half-million individuals. Call it an even million. That's just over 2% of the uninsured. It's progress, sure, but when you frame it that way it feels like hyper-incrementalist bullshit. Hopefully whatever health care reform we end up passing will have a larger impact than any of the individual proposals the CBO is looking at here.