His signature charge, here and elsewhere, is that the Democrats are not serious about cost control because supporters of the excise tax on expensive policies have allowed that tax to be weakened:
Fifth, you got to see at least one area of bipartisan agreement. Neither side was willing to be specific about how to cut costs and raise revenue. The Republicans continued to demagogue efforts to restrain Medicare spending. The Democrats (and the Republicans) conveniently neglected to mention the fact that they had just gutted the long-term revenue source for their entire package, the excise tax on high-cost insurance plans. That tax was diluted and postponed until 2018. There is no way that members of a Congress eight years from now are going to accede to a $1 trillion tax increase to pay for a measure that the 2010 Congress wasn’t brave enough to pay for itself.
First, it is just plain slander to assert that the Democrats are unwilling to be specific about how to raise revenue. The House bill has no excise tax, but it is deficit neutral -- it raises money from other taxes, such as a surtax on high earners, while the Obama plan published in advance of the summit adds a new Medicare surtax on capital gains for high earners. Second, as Atul Gawande has documented in exhaustive detail and as a group of top health care economists led by Dr. Alan Garber has affirmed, the bill deploys just about every means of cost control that health care experts deem to have potential -- coordinated care teams, incentives for results and penalties for not meeting standards on measures such as hospital readmissions, a MedPAC commission with real authority -- and yes, the excise tax, albeit delayed.
Third, it is always suspect to speak of "courage" when dealing with collective bodies. The excise tax has not been weakened because of a lack of "courage." Indeed, Obama has gone to the mat for it as he never did for the public option -- as Ezra Klein predicted he would long ago. Unions and their closest allies in the House have had the 'courage' to risk the entire bill to weaken this tax. Cost control hawks have had the "courage" not to let it go. Any further "courage" on their part would doom the bill to failure.
