One side says that the Affordable Care Act, if allowed to work, will reduce the deficit by $100 billion over 10 years, and by more than $1 trillion over 20 years, and to repeal it would be disastrous.
The other side says the Affordable Care Act will increase the deficit by $700 billion in the next ten years, and to not repeal it as soon as possible would be an act of fiscal insanity.
Unless the whole world has slipped down a rabbit hole, both sides cannot be right.
The U.S. House of Representatives, where a Republican majority now reins for the first time in four years, is considering a bill that would repeal the ACA, also known as the healthcare reform act. Republican candidates ran on a pledge to do so and started the process in their first days in power this week.
The House will probably repeal healthcare reform next week.
The bill will then go to the Senate, which is still in control of the Democrats, who have vowed to kill the bill on arrival.
If by some legislative miracle, the repeal passes the Senate, President Obama, a Democrat, has sworn to veto it.
In the very likely event of defeat in the Senate of the repeal, House Republicans have promised to repeal the ACA provision by provision, sending each of these repeals to the Senate, where Democratic Senators are almost certain to kill each bill.
This sort of thing could go on for quite some time, until the rest of the nation thinks that it, or at least Washington, D.C., has slipped down a rabbit hole.
Perhaps neither side is right about their figures. But which side, the repealing Republicans or the defending Democrats, is closer to the truth?
The government agency tasked with estimating the consequent costs of acts of Congress is the Congressional Budget Office. As the Obama administration and Congressional Democrats have repeatedly pointed out in the healthcare debate, both while trying to pass the law last year and now, trying to defend it, the CBO has estimated that the healthcare reform act will reduce the deficit by $100 billion over 10 years, and by more than $1 trillion over 20 years.
But Republicans, backed by several conservative scholars, have questioned how the CBO arrived at its estimates. One of those scholars is Douglas Holtz-Eakin, a former director of the CBO.
Holtz-Eakin, in a recent article, said that the CBO, by law, must used the information given it by Congress and Congress, under Democratic control for the last four years, fed the CBO skewed information.
The rules the CBO functions under forced CBO to incorporate a wide range of budget gimmicks in their original estimate of the health care law, Holtz-Eakin said.
For example, the CBO is forced to pretend that over $450 billion in payment cuts to Medicare providers will be possible without changing in any real way the operation of Medicare, he said.
For this and similar reasons, Holtz-Eakin has estimated that the first 10 years of the ACA will add $700 billion to the deficit. New Speaker of the House John Boehner, R-OH, and his Republican colleagues are echoing Holtz-Eakin's logic and figures.
Henry Aaron, senior fellow at the Brookings Institute, although he readily admits that the CBO is not perfect, thinks that its estimates should be respected.
Some say the CBO has understated the numbers. Others say it has overstated the numbers. I say the prudent thing is to use the CBO estimates, Aaron said.
Aaron called the CBO staff a group of honest professionals grappling with the vast uncertainties of a very complex law.
Healthcare reform is, first and foremost, a commitment to large-scale institutional changes, the consequences of which are difficult to impossible to predict, he said.
Regarding the payment cuts to Medicare providers mentioned by Holtz-Eakin, Aaron explained that the ACA revises downward reimbursement rates to hospitals and nursing homes, which are not severe, but, over time, could become severe.
But the law envisions positive changes in the productivity of hospitals and nursing homes, through innovations, administrative improvements and other efficiencies that will offset and justify the lesser rates of reimbursement, he said.
No one knows if these positive changes will actually occur. Everything in such a huge endeavor into uncharted waters is iffy, Aaron said.
But we have agreed to give the CBO the umpire's role and both sides should respect that, Aaron said.
He called it foolhardy and dangerous to just start rolling out other predictions and estimates because the CBO's are not satisfactory to your position.
Lawmakers often use the CBO estimates when the estimates suit their plans and tend to ignore or refute them when they don't.
Both Democrats and Republicans are guilty of this, Aaron said. In the current case, it appears the Republicans are the more guilty.
The CBO always scores with a degree of uncertainty and the magnitude of the changes embodied in the ACA increases that degree.
All sorts of things could change. The law expects many things to change. Some of the changes are going to be beyond anyone's ability to predict.
It can be safely predicted, however, that healthcare reform will be controversial for months to come.