Long-term scoring bolsters deficit reduction and sound health policy

This week, a study released by a leading economist, Alex Brill, highlights shortcomings in how Congress estimates the costs of health proposals: our model timelines are too short to capture the true effects of good legislation.  So while we work to advance policies that help address the prevalence of chronic diseases – including obesity, diabetes and heart disease –our budgeters do not tell us whether these policies will work in the long-term and what savings they generate.

As I learned when I came to Washington, the Budget Act of 1974 requires the Congressional Budget Office (CBO) to produce cost estimates for policy proposals, currently, using a 10-year estimate of net costs.  However, there is no rule forbidding longer-term analyses.  Indeed, as this week’s report –published by the Campaign to End Obesity – notes, CBO has recently provided 75-year forecasts to calculate Social Security obligations, and to determine the revenue impact of increased tobacco taxes.  Since CBO already has these capabilities, we need to acknowledge the benefits associated with decreased rates of chronic diseases – including the benefits achieved well outside of the 10-year estimate.  These capabilities would help Members of Congress better understand the impacts of policy proposals.

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Using the 10-year model to evaluate federal policies is a barrier to the enactment of effective health policies and bad for our economy.  We should be equipping ourselves with long-term analyses that will enable Congress to invest in effective health policies that will pay long-term dividends in both health and fiscal terms.

Today, chronic disease care accounts for 75 percent of health spending in America – including over $200 billion annually attributed to obesity.  Brill’s analysis finds that there are potentially billions in dollars in savings resulting from evidence-based obesity reduction policies.  Think about the policy choices we might make if we knew that, at year 15 or year 50, policy costs could be offset by savings realized from not having to treat costly chronic diseases. 

Certainly, Congress shouldn’t just pass any proposal labeled a “preventive health” program.  Indeed, a long-term model will tell us more about the programs that will work and those that may not.  Knowing whether our investments are likely to yield results is sound policy.  It is incumbent on a Congress that is struggling to find ways to fix our long term economic woes that we have the tools to meet this challenge.

This is why last Congress I introduced a bill to address this issue, H.R. 6482, “To amend the Congressional Budget Act of 1974 respecting the scoring of preventive health savings”. My bill, co-authored by Representative Donna Christensen, M.D. (D-VI), recognizes the possible savings that could be achieved by allowing CBO to expand its scoring window in certain circumstances. This bill doesn’t spend any new money, but instead enables Congress to better understand the possible cost-savings that effective interventions could have when they are applied in government health programs, such as Medicare and Medicaid.

When we talk about leaving a dangerous economic legacy to our children and grandchildren, we should also consider whether we are saddling them even further by failing to make sound investments today in effective policy measures.  Brill’s report tells us that we need to apply long-term economic thinking to addressing rising rates of chronic diseases.  It is time we find ways to use long-term analyses, so we can make choices that support a healthier America and a stronger economy.
Rep. Michael C. Burgess, M.D. is a Republican from Texas.