Debate on the so-called “extenders” bill has focused on the size and duration of unemployment benefits, health insurance assistance for those who recently lost their jobs, Medicare physician payments, state aid for health care and various offsets to mitigate the overall effect on the deficit.

Conspicuously missing from the debate is any scrutiny of the extenders themselves. It’s a missed opportunity to raise needed revenue while simplifying the tax code and broadening the tax base -- goals that economists of all ideological stripes have long advocated. 

Both the House and Senate versions of the extenders bill contain more than 60 narrowly targeted tax breaks that expired last year. Extending them just through this year will cost about $32 billion. The long-term cost runs to over $350 billion. That cost will add to the debt unless it is offset by corresponding tax increases or spending cuts that may prove more harmful to the economy than failing to renew some, or all, of the extenders. 

At a time when the President is commendably urging all federal agencies to identify their lowest priority and least effective items, Congress should devote the same level of scrutiny to the tax code. The extenders would be a good place to...

It looks like we might be entering the final week(s) of (at least) this year's legislative push on health care reform.

Thursday brought us legislative text of the amendments to the Senate bill that the House will take up through the reconciliation process as well as an updated CBO score of the whole package. It is likely the House will vote on the bill package Sunday. If they do so, the Senate bill will become the law of the land, and the reconciliation amendments will then have to make it though the Senate before those become law.

The main fiscal takeaway from this week is that there really has not been any substantial change in what heath care reform is attempting to accomplish and whether it will ultimately be fiscally responsible legislation. Today we released a series of video discussions (see above) between Bob Bixby and I explaining the big picture and how the reconciliation tweaks effect that. One of the issues discussed is that clearly the most consequential fiscal change through reconciliation is the delay in implementation of the excise tax on cost insurance plans.

For a more complete view, our December Issue Brief, created as the Senate bill neared passage,...

As the White House and congressional leaders rethink health care reform after the Republican upset in the Massachusetts Senate race, there is a growing danger that Congress will jettison comprehensive health care reform altogether. Even worse, they might pass stripped-down measures that eliminate politically difficult cost-containment, while popular but costly provisions are kept.

President Obama has suggested narrowing the focus of national reform, advising that Congress should “try to move quickly to coalesce around those elements of the package that people agree on.” Some members of Congress have also expressed support for a limited bill.

However, most policy experts agree that a limited bill is nearly impossible to construct without running into some major issues with short and long-term costs. That is because the easier elements -- the ones that “people agree on” -- are interlocked with elements whose benefits are far less apparent to many voters.

The key reforms for the health insurance industry are popular -- for instance, prohibiting discrimination based on pre-existing conditions. Yet, just doing that would lead to an insurance "death spiral" where only the sick would get insurance when needed, driving up the cost of premiums. The only way around this spiral is to have an individual mandate to...

When discussing health care reform, if we cannot even be clear that “advance care planning” is in no way, shape or form the same as a “death panel,” how will we ever be able to talk about the real (and factual) challenges facing the Medicare program and its long-term sustainability?

Ugh….

Let’s be clear: there are no “death panels” included in the health reform bills adopted by the House of Representatives and the Senate, although misinformation on this topic has been swirling for months. For example, last August during the Congressional recess I was quite distraught when my own Senator Charles Grassley stated in an Iowa town hall meeting that he was worried that efforts to increase the efficiency of Medicare or to create an Independent Medicare Advisory Commission would indeed mean that the federal government would be making decisions about when to “pull the plug on Grandma.” More recently, the clause in the House bill that allowed reimbursement to Medicare providers who hold “advanced care planning consultations” with their patients has been equated with a “death panel” deciding when a senior would die.  Nothing could be further from the truth.

Having studied end of life care in graduate school and...