"We do not see the sort of fundamental changes that would be necessary to reduce the trajectory of federal health spending by a significant amount and, on the contrary, the legislation significantly expands the federal responsibility for health care costs"
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Elmendorf isn’t lamenting health care costs so much as he’s doing what economists do best: stripping a feel-good policy story down to its budgetary skeleton. The sentence is built like a door closing. First, the calm, technical premise: “We do not see the sort of fundamental changes...” That’s Washington code for “the reforms being advertised are incremental at best.” He avoids calling anyone unserious; instead, he invokes an absent standard of “fundamental changes” and lets the implication land on its own.
Then comes the pivot that matters: “and, on the contrary.” It’s a small phrase with prosecutorial force. The subtext is that the legislation’s rhetoric (cost control, bending the curve) is being outpaced by its mechanics (expanded coverage, subsidies, new entitlements). Elmendorf is flagging a familiar paradox in U.S. health policy: lawmakers promise savings through efficiency, but the political incentive is to broaden benefits now and postpone pain later.
Context sharpens it. As a CBO director figure, he’s positioned as the referee in a game where both teams accuse the ref of bias. So he writes in institutional understatement, almost daring partisans to argue with the baseline reality of federal obligation. “Expands the federal responsibility” is doing double duty: it’s a descriptive budget fact and a warning about path dependence. Once Washington takes on a cost, it rarely gives it back. The line isn’t moralizing; it’s telling you where the ratchet points.
Then comes the pivot that matters: “and, on the contrary.” It’s a small phrase with prosecutorial force. The subtext is that the legislation’s rhetoric (cost control, bending the curve) is being outpaced by its mechanics (expanded coverage, subsidies, new entitlements). Elmendorf is flagging a familiar paradox in U.S. health policy: lawmakers promise savings through efficiency, but the political incentive is to broaden benefits now and postpone pain later.
Context sharpens it. As a CBO director figure, he’s positioned as the referee in a game where both teams accuse the ref of bias. So he writes in institutional understatement, almost daring partisans to argue with the baseline reality of federal obligation. “Expands the federal responsibility” is doing double duty: it’s a descriptive budget fact and a warning about path dependence. Once Washington takes on a cost, it rarely gives it back. The line isn’t moralizing; it’s telling you where the ratchet points.
Quote Details
| Topic | Health |
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