Budget Wars: Can They Bridge the Health Care Gap?

Bud­get debates make good polit­i­cal the­ater. Each par­ty forces record­ed votes designed to score polit­i­cal points and embar­rass mem­bers of the oppos­ing par­ty. The House had fun yes­ter­day with some amend­ments before adopt­ing the Repub­li­can pro­pos­al writ­ten by Paul Ryan (R‑WI). The Sen­ate began debate on its pro­pos­al last evening and is brac­ing for Friday’s “vote-a-rama” – a day of record­ed votes on dozens of polit­i­cal­ly-barbed amend­ments advanced by mem­bers of both parties.

In this post, I’m going to try to look past the the­atrics and, doing my best to be impar­tial, make a few high-lev­el obser­va­tions about the Sen­ate Demo­c­ra­t­ic and House Repub­li­can pro­pos­als. To do that, I’m going to use this chart (click to enlarge):

 Chart for post 032013

The chart presents rev­enues, out­lays and deficits under four sep­a­rate headings:

40-year average.

The blue bars rep­re­sent the aver­age rev­enues, out­lays and deficits between 1972 and 2011. CBO pre­sent­ed these aver­age num­bers last year. They rep­re­sent the lev­el of fed­er­al tax­es and spend­ing that we have been accus­tomed to for most or all of our lives. Both bud­gets would change this well-estab­lished fis­cal pat­tern, but in very dif­fer­ent ways.

CBO “baseline” average for the next 10 years.

Where­as the first bar in each clus­ter looked back over the past four decades, the next three look for­ward. The sec­ond bar rep­re­sents what CBO expects to hap­pen over the next decade (2014–2023), assum­ing the Pres­i­dent and Con­gress make no changes to exist­ing law – no tax hikes or cuts; no increas­es or decreas­es in enti­tle­ment spend­ing. It’s what fis­cal pol­i­cy would look like if the gov­ern­ment went on auto-pilot, con­tin­u­ing to col­lect tax­es, spend and bor­row mon­ey accord­ing to laws already in place. This, too, is a pret­ty sharp depar­ture from what we’ve been used to over the past four decades.

Senate Democratic proposal for the next 10 years.

The green bars (no, that’s not a state­ment on the envi­ron­ment) rep­re­sent the res­o­lu­tion that the Sen­ate began debate on last evening. It is expect­ed to pass the Sen­ate lat­er this week.

House Republican proposal for the next 10 years.

The bar on the far right (no pun intend­ed) in each clus­ter rep­re­sents the House GOP pro­pos­al that passed ear­li­er yesterday.

I’ve done two things in this chart that I hope make it eas­i­er to under­stand. First, I’ve expressed the tax and spend­ing plans as per­cent­ages of gross domes­tic prod­uct (GDP), which is the total out­put of the Amer­i­can econ­o­my. That elim­i­nates hav­ing to account for the fact that a 1971 dol­lar is worth a heck­u­va lot more than a dol­lar is worth today or will be worth 10 years from now. More impor­tant­ly, it enables me to say that the Democ­rats want fed­er­al spend­ing to aver­age 21.7 per­cent of GDP over the next decade; that’s a lot eas­i­er to read than the $46,362,049,000,000 that their bud­get pro­pos­es to spend.

Sec­ond, I’ve looked at “aver­age” spend­ing, because that’s lots sim­pler than look­ing at sev­er­al lines that change from year to year. Hope­ful­ly, this sim­pli­fies the pre­sen­ta­tion with­out oversimplification.

Here are a few observations:

Brace for higher taxes.

The bud­get process is just begin­ning and there are such sig­nif­i­cant dif­fer­ences between the House and Sen­ate plans that many observers believe an agree­ment to be impos­si­ble. If talks col­lapse and tax pol­i­cy remains unchanged, the fed­er­al gov­ern­ment will col­lect tax­es amount­ing to 18.9 per­cent of eco­nom­ic out­put over the next 10 years. That’s 1 per­cent of GDP high­er than over the past 40 years. Think 1 per­cent of GDP isn’t much? Think again. The gov­ern­ment will col­lect $2.1 tril­lion more in tax­es over the next 10 years than if they stuck with the his­tor­i­cal rev­enue rate. That’s real mon­ey and you’ll feel the difference.

Both parties have climbed on the higher tax bandwagon.

The gen­er­al per­cep­tion is that Repub­li­cans want to cut tax­es and Democ­rats want to raise them. These charts demon­strate that isn’t quite the case. The Demo­c­ra­t­ic bud­get does call for high­er tax­es. Under their mea­sure, fed­er­al rev­enues would aver­age 19.3 per­cent of GDP, 0.4 per­cent more than under cur­rent law and 1.4 per­cent more than the 40-year aver­age. But Repub­li­cans aren’t tax slack­ers. Their pro­ject­ed rev­enue is just a tick below the CBO base­line of 18.9 per­cent. That rep­re­sents a big change for the par­ty. More on that below.

Both budgets reduce the deficit.

The Demo­c­ra­t­ic bud­get would reduce the aver­age deficit to 2.4 per­cent of GDP, sig­nif­i­cant­ly low­er than both the his­tor­i­cal aver­age and the CBO base­line for the next 10 years. Repub­li­cans go them one bet­ter, elim­i­nat­ing the deficit entire­ly in 2023.

The two sides aren’t in the same area code on spending.

While the pub­lic debate often fix­ates on tax­es, the most dra­mat­ic dif­fer­ence between the two par­ties is in spend­ing. The Demo­c­ra­t­ic bud­get would spend, on aver­age, 21.7 per­cent of GDP, rough­ly split­ting the dif­fer­ence between the his­tor­i­cal aver­age (21.0 per­cent) and the CBO base­line pro­jec­tion (22.1 per­cent). The GOP bud­get would cut sub­stan­tial­ly below both. The gap between the two pro­pos­als is enor­mous, with the House bud­get propos­ing to spend about $5 tril­lion less than the Sen­ate bud­get. That dwarfs the dif­fer­ences between the two sides on tax­es, where less than $1 tril­lion sep­a­rates the two sides. Not that $1 tril­lion isn’t a lot of mon­ey; it’s an aver­age of $100 bil­lion per year. But the dif­fer­ence on the spend­ing side is about 5 times as great.

Despite that difference, the two budgets are generally in the same ballpark in many areas of spending.

Nei­ther side wants to touch Social Secu­ri­ty and, despite philo­soph­i­cal dif­fer­ences on Medicare, they’re not all that far apart. Democ­rats pro­pose to spend $6.74 tril­lion on the pro­gram, Repub­li­cans $6.56 tril­lion, a fig­ure rough­ly 2.6 per­cent less. Both sides would drop defense and domes­tic dis­cre­tionary spend­ing below his­toric lev­els, although Repub­li­cans advo­cate much deep­er cuts in domes­tic spend­ing. I don’t want to paper over the dif­fer­ences here. Clear­ly, Repub­li­cans want a much more aus­tere gov­ern­ment than do Democ­rats and that aus­ter­i­ty is reflect­ed vir­tu­al­ly across the board in spend­ing. But these dif­fer­ences would seem to me to be bridge­able were it not for the health law.

Health care is the biggest bone of contention between the two budget proposals.

If the two sides are going to reach agree­ment on the bud­get, they are going to have to find some out­side-the-box accord on the new health law. No sin­gle dif­fer­ence between the two bud­gets is quite that big – not tax­es, not oth­er enti­tle­ment spend­ing (includ­ing Medicare), not nation­al secu­ri­ty or even domes­tic dis­cre­tionary spend­ing. This is all the more sur­pris­ing since House Repub­li­cans have agreed to adopt sev­er­al impor­tant fea­tures of a law that they have long vowed to repeal. They pret­ty much accept its new tax­es and its $700 bil­lion in Medicare cuts that Mitt Rom­ney (and Paul Ryan) cam­paigned against last fall. But they don’t accept the spend­ing and that is prodi­gious. By assum­ing repeal of the health law’s spend­ing pro­vi­sions, the GOP bud­get saves almost $2 tril­lion — $1.25 tril­lion from elim­i­nat­ing health insur­ance sub­si­dies, $635 bil­lion from nix­ing the Med­ic­aid expan­sion and anoth­er $23 bil­lion in relat­ed sav­ings. That’s a lot of sav­ings and some­thing to which most Con­gres­sion­al Democ­rats and the Pres­i­dent are unal­ter­ably opposed.

This post is too long (I promise future posts will be briefer) and too short – it deals in very high-lev­el gen­er­al­i­ties and gloss­es over a whole lot of detail in the process. Its pur­pose is to lay out some gen­er­al thoughts on the bud­get and to show how health care may well prove to be the issue that stymies any grand agreement.

Those are my gen­er­al thoughts. What are yours?