"Max in Wonderland"--Yes, Budget Projections Are Fanciful, But There Are Real-World Consequences.

That's the title of a terrific article from David Harsanyi, detailing--OK, mocking--the number-adjudicating efforts of Sen. Max Baucus, chairman of the Senate Finance Committee. Harsanyi opens up a whole vein of thought, leading us to wonder: Do any of these numbers mean anything, or have we just created a fantasyland where the numbers are plucked at random, like caps from a field of magic mushrooms?

Baucus needs to “hit the number”--that is, produce a cost/deficit number that’s acceptable to a critical mass of Senators, so that Baucus can get his bill through the Senate, and then on to the House, and then to the President’s desk. And where does that number come from? From the Congressional Budget Office (CBO), which is its own black box of number-crunchery, based on the vaguest of numerical inputs. It's not CBO's fault; the agency is a creature of Congress, so in the end, it will always do what Congress wants it to do.

As Harsanyi observes, “The CBO's new estimate, which magically meets every one of President Barack Obama's preconditions, is based on “conceptual’ language provided by Baucus rather than on any of those maddeningly specific Arabic numerals.”

And then Harsanyi continues:

According to the CBO, the Senate plan--which actually would cost more than earlier estimates, rising from nearly $800 billion to $829 billion (or $904 billion, according to a number of economists)--has triggered many excited journalists and politicians to claim that the bill miraculously would "pay for itself."

The CBO says that not only would it pay for itself--and this part is really wonderful--but also the government's spending an additional $829 billion over the next 10 years would reduce the federal deficit by $81 billion.

How exactly does health care "reform" pay for itself in Wonderland? In this case, it pays for itself by charging taxpayers new "fees," delivering new mandates and penalties, adding pass-through costs, and cutting hundreds of billions of dollars from Medicare.

What fees are those? There will be time to detail those later, but the main point now is to remember that the numbers attached to the fees, like the fees themselves, are highly arbitrary. The purpose of the numbers is not to serve the truth, but rather, to serve the purposes of the sayer, be they true, false, or just unknown.

And so I am reminded of the scene in Lewis Carroll’s sequel to Alice in Wonderland, Through the Looking Glass, in which Humpty-Dumpty says that words mean whatever he says that they mean. In the passage below, from Looking Glass, one might simply substitute “numbers” for “words” and you will see what I mean:

‘When I use a word,’ Humpty Dumpty said, in rather a scornful tone, ‘it means just what I choose it to mean – neither more nor less.’

‘The question is,’ said Alice, ‘whether you can make words mean so many different things.’

‘The question is,’ said Humpty Dumpty, ‘which is to be master – that's all.’

Alice was too much puzzled to say anything; so after a minute Humpty Dumpty began again. ‘They've a temper, some of them – particularly verbs: they're the proudest – adjectives you can do anything with, but not verbs – however, I can manage the whole lot of them! Impenetrability! That's what I say!’

‘Would you tell me please,’ said Alice, ‘what that means?’

‘Now you talk like a reasonable child,’ said Humpty Dumpty, looking very much pleased. ‘I meant by “impenetrability” that we've had enough of that subject, and it would be just as well if you'd mention what you mean to do next, as I suppose you don't mean to stop here all the rest of your life.’

‘That's a great deal to make one word mean,’ Alice said in a thoughtful tone.

‘When I make a word do a lot of work like that,’ said Humpty Dumpty, ‘I always pay it extra.’

‘Oh!’ said Alice.

In the hands of Lewis Carroll, such reality-bending--the question of who has mastery over meaning, the person or the word itself--is playful and adorable.

But in the hands of Max & The Magic Bean Counters, aka Sen. Baucus and the Congressional Budget Office, the process of bending reality, to produce the needed politically expedient number, is simply cynical--beyond cynical, if that’s possible in DC.

The legislative process that got us this far hasn't been transparent, of course, but even it were transparent, there's the obvious reality that nobody knows what the numbers really mean. The process can be perfectly transparent, but if the thing itself--the throughput--is completely opaque, then nothing has been gained.

That was a point made by Anna Edney of Congress Daily, in a piece entitled,"Moderate Dems Wary Of CBO Numbers On Baucus Measure." Of course they are wary--they should be! The numbers might be fake, but the elections that incumbents will be facing, starting in 2010, are real enough.

And The Washington Examiner's Michael Barone adds a bit moreon Monday, in a piece entitled, “‘Conceptual Language’ Hides Health Care's Costs.” Barone begins by joking that some headlines are not to believed, other than, of course, the headline that Barack Obama just won the Nobel Peace Prize:

I'm referring to the headlines earlier in the week to the effect that the health care bill sponsored by Senate Finance Committee Chairman Max Baucus will cut the federal deficit by $81 billion over the next 10 years.

Yes, that is what the Congressional Budget Office estimated. But, as the CBO noted, there's no actual Baucus bill, just some "conceptual language." Actual language, CBO noted, might result in "significant changes" in its estimates. No wonder Democratic congressional leaders killed requirements that the actual language be posted on the Internet for 72 hours before Congress votes.

Indeed. The point here is that because numbers are taken to mean everything, the numbers are superseding everything else. Like good policy. LIke good health.

Thus the bean-counters, issuing their numbers, have supplanted judgment as to what's best for American healthcare. It's not the fault of the bean-counters, they've been asked to do it. It's the fault of the politicians, who did the asking.

And so fixing this mess will be a job for the voters, who, at the rate things are going, are likely to wake up and realize that they are paying higher prices for worse healthcare. And no prospect, based on anything that Washington is doing, for more medicines and more cures.

Here at Serious Medicine Strategy, I have suspected, all along, that this would be the outcome. For all of 2009, I have heard about "health insurance," and "health management," but I have heard little or nothing about better health outcomes through new discoveries and innovations. And so here we are: in a numbers la-la land, where the only thing real is the grinding reality that people are still dying.