Senators Talk Schedule; CBO Eyes Medical Malpractice

"We need to stay in," McCain said. "We need to know what the proposals are."

Sen. Max Baucus, D-Mont., called the Republicans' arguments "a little surreal."

"They say they want to move ahead, and then they refuse to enter into any reasonable time agreement to consider a necessary appropriations measure," Baucus said. "I'm very impressed how the minority can maintain both that they want to move more quickly and not move at all."

Also today:

- Sen. Bernard Sanders, Independent-Vt., who identifies himself as a democratic socialist, denounced the H.R. 3590 provision that would impose a 40% "Cadillac plan" excise tax on health benefits with a value over a certain level.

"I think that's wrong," Sanders said. "I think that is regressive…. Let me tell you, give the soaring cost of health care in America today, what maybe a Cadillac plan today is going to be a junk car plan in 5 years from now. Millions of Americans are going to be forced to pay taxes on their health care benefits, or else their employer is going to come back on those benefits and they're going to have to pay for them out of their own pocket."

- CBO Director Douglas Elmendorf wrote to Sen. John Rockefeller IV, D-W.Va., to explain why one recent CBO analysis suggested a common package of medical malpractice reform proposals would lead to about $5 billion in spending decreases and revenue increases from 2010 to 2019, and another analysis suggested the package would lead to $54 billion in spending decreases and revenue increases over the same period.

Many Republicans and some Democrats would like the Senate health bill to put more emphasis on medical malpractice reform as means of reducing health care costs. Critics of that strategy have argued that efforts to change the malpractice system would have little effect on overall health care costs, or that the effects are too hard to estimate.

Elmendorf says the CBO analysis showing that medical malpractice system changes would have a bigger impact, prepared for Sen. Orrin Hatch, R-Utah, includes a larger estimate of the effect of tort reform on malpractice costs; the effect of a gradual shift away from defensive medicine on medical spending; and the effect of a shift away from defensive medicine on federal health program spending.

The CBO believes "the combination of direct savings in malpractice costs and indirect savings in health care services would reduce national health spending in response to the proposed reforms by roughly 0.5%," Elmendorf writes.

The CBO also has increased its estimate of the effects of tort reform on medical malpractice insurance costs, Elmendorf writes.

The CBO now believes tort reform could cut malpractice insurance costs 10%, Elmendorf writes. Earlier, the CBO had estimated the reduction would be about 6%.