There is little debate about what President Joe Biden’s recent budget proposal represents. The big numbers speak for themselves: $ 6 trillion in federal spending this year, rising to over $ 8 trillion in a decade, with deficits totaling at least $ 1.3 trillion each year. It’s a budget plan that The New York TimesâIn a press article, not an opinion pieceârecently described as a call for “a permanent increase in the size of the federal footprint on the US economy” and “an attempt to expand the size and scope of federal engagement in the day-to-day lives of Americans.”
Biden’s budget plan is a proposal, not a law, and it was not passed by Congress. But it’s a vision of America’s fiscal future in which a dramatically enlarged federal government is at the center of much of day-to-day life. And if anything, his vision is actually bigger than the main numbers represent.
It’s because Biden’s budget includes rhetorical support for a number of policies that he omits from his cost estimates. In particular, it expresses its support for expanding Medicare, already among the most expensive federal programs, by adding new benefits and expanding eligibility options to people as young as 60 years old.
He also calls for the creation of a “public option” – a government-run health plan that would be sold alongside regulated private insurance plans on health insurance plans created under the Care Act. affordable, also known as Obamacare.
Some reports have called this move Biden Leave besides the public option, frustrating progressives who have long supported the creation of a government-run insurance scheme. But while it’s true that neither the public option nor the Medicare expansion is included in Biden’s budget estimates, I think that’s not quite the right way to read the President’s budget.
It’s not that Biden left these healthcare extensions outside of his budget. It is because he included them, without detailing how they would work or how much they would cost. Biden’s budget is an attempt to push for these policies without having to wade through the political mechanisms that are sure to be controversial or the additional budgetary costs they would entail.
Biden’s budget plan doesn’t just vaguely suggest that expanding Medicare and creating a public option might be a good thing. Instead, in a paragraph that opens with an explicit call to Congress “to take action this year to further strengthen health care” by “expanding and improving health coverage,” he says the expansion of medicare, the creation of a public option and a number of other health care policies are all part of the “president’s health care agenda.”
The Biden administration said before the budget is released that several major health care initiatives had been postponed and that the budget would not âcome up with new initiativesâ, and that is quite true in a certain technical sense.
But the clear expression of support means that it is, in fact, off-budget policies. But they would have a significant impact on both the budget and the delivery of health services. Biden just won’t say what that impact would be.
Biden’s reluctance to clarify how either policy would work dates back to his campaign. As the Kaiser Family Foundation recently Noted, Biden’s campaign proposal to allow people aged 60 to 64 to use Medicare leaves out many details: “Important features of the policy design have yet to be specified, including how it would be funded or administered. To put it a little more bluntly, there isn’t really a plan here. But there is no doubt that adding millions of people to Medicare would increase total federal spending on health care.
Likewise, Biden declined to provide much detail on how a government-run health insurance plan works. Some analyzes in the past have suggested that a public option could reduce the deficit. But such analyzes also assume that the public option, like Medicare, would pay healthcare providers much lower rates than private insurance. Yet paying lower rates inevitably threatens patients’ access to care, especially in rural hospitals that serve the poorest populations.
This helps to explain why it has been politically difficult to make such plans work: several years ago, Washington State Democrats tried to implement a state-run public option with rates close to health insurance. It only happened after the rate hike.
A recent article by a trio of political analysts at the Hoover Institution, meanwhile, found that depending on how it was implemented and the taxes used to offset the cost of the program, a public option could end up becoming the third largest federal program and run a $ 800 billion deficit. of dollars during its first decade of operation. . And because Congress would have control over the health insurance premiums charged by a government-run plan, it’s easy to imagine that lawmakers would report to significant pressure to cap or otherwise limit increases in these premiumsâCompensating the difference with additional taxes or deficit spending.
The point is, this is all contentious, and any real plan would inevitably spark significant debate and opposition from a wide constellation of interests. But Biden didn’t want to have these debates or answer specific questions about his policies, so he tried to play both ways, supporting some major policy initiatives while pointedly refusing to say how those initiatives would affect the budget. Which means Biden’s expansive and expensive budget plan – his vision for the federal government’s fiscal future – is likely much bigger and more expensive than even the headlines seem.