I had missed this from the President’s remarks to Congress on February 24th:

This budget builds on these reforms. It includes a historic commitment to comprehensive health care reform – a down-payment on the principle that we must have quality, affordable health care for every American.

Budget Director Peter Orszag repeated the “down payment” language on his blog Monday, and was slightly more specific:

And in the President’s budget, we make a historic down payment on fundamental health care reform – a commitment also embodied in the budget resolutions passed in Congress.

This clearly suggests that the Administration thinks that the $634 B “reserved” over the next ten years in the President’s budget (table S-6) will not suffice to fulfill “the principle that we must have quality, affordable health care for every American.” By combining and repeating the “down payment” language with the “every American” language, they are covering themselves for later as they now create a political commitment that exceeds their budgetary commitment.

There are two other details to the President’s language that are interesting, and that he has repeated several times since the February address:

  1. He says all Americans should have “health care” rather than “health insurance.” This allows him wiggle room to accept a solution that does not provide universal pre-paid health insurance coverage for every American. This mitigates my down payment point somewhat, but only if the Congress decides to go for less than universal coverage. I would lay extremely high odds that before this speech there was a West Wing debate about whether the President should say “health care” or “health insurance,” with the Lefties arguing for “insurance” and getting overruled to allow flexibility to later define a win with legislation that provides something less than universal coverage.
  2. He consistently says “quality health care” or “high-quality health care.” That is more expensive than “basic health care,” and opens the question about who defines “high quality,” as well as the government-mandated benefits problem.

The growth of federal health care spending is one of our top two short-term and long-term budgetary problems. The President’s budget commits to making that problem worse by creating a new promise, only partially funding that promise, and then not specifying policies that will produce the long-term savings for which the Administration wants to claim credit. I am stunned that the White House staff let the President say this without the policies and numbers to back it up:

It’s a commitment that’s paid for in part by efficiencies in our system that are long overdue. And it’s a step we must take if we hope to bring down our deficit in the years to come.

I am not disappointed but not surprised that the press corps has not called the Administration to back this claim up. I can find no evidence of policies that will produce “efficiencies in our system,” or that will “bring down our deficit in the years to come.” As CBO wrote in December, better information and research alone will not achieve those goals.