CBO has the loudest voice

It's the kind of dry issue that bores even the most scholarly members of Congress. "CBO scoring" even sounds boring.

But when it comes to health-care reform and the current debate on Capitol Hill, CBO scoring might be the most important game in town. CBO stands for Congressional Budget Office, and scoring is how it predicts programs and policies will affect the federal budget.

Generally speaking, the House and Senate do not move forward on policies affecting the federal budget - basically, any policy - without consulting the nonpartisan experts at the CBO, three-fourths of whom hold advanced degrees from places like Harvard, Princeton, and Stanford. In the CBO's own words, "Every piece of legislation affecting the use of the nation's resources undergoes CBO's scrutiny."

The CBO's importance was underscored following the announcement on Monday that six of the nation's most important health-care interests - including the pharmaceutical industry, insurance companies, and hospitals - have identified $2 trillion in savings over the next 10 years. Just hours after the White House announcement, Chuck Grassley, the ranking Republican on the Senate Finance Committee, said, "For health-care budgeting purposes, CBO's word is the only one that counts."

The Congressional Budget Office is required to develop cost estimates for carrying out any legislation that comes out of congressional committees. CBO scoring keeps track of all this proposed spending so Congress knows if it is reaching previously established federal spending targets.

Right now, the CBO is trying to figure out how to score the various health-care reform proposals. In many respects, that is the most important discussion being held in our nation's capital.

A New Jersey group that I chair, the Partnership to Fight Chronic Disease, has asked the CBO to look at the health-care proposals a little differently.

For instance, the CBO's cost estimates typically cover the first 10 years after the enactment of a piece of legislation. For policy changes that improve health, however, returns on investment often take more than 10 years. The savings generated by reducing obesity among kids will not affect the federal budget until the kids are adults (or maybe even seniors entering Medicare). This is important if a reform proposal is trying to prevent costly chronic diseases.

The partnership is suggesting several changes in CBO scoring practices to achieve a more accurate picture of the budget implications of health-care reform. In a letter to congressional leaders, we recommended the following:

A revision of baseline cost estimates to take into account the deteriorating health of the population and the estimated impact of this trend on spending in the years ahead.

Scoring of savings beyond the commonly accepted 10-year window to capture the long-term value of health improvements.

Consideration of the broader economic impact of improved health through increased productivity.

Numerous New Jersey organizations signed on to the letter, including unions, health-care providers, and patients' advocates. These changes make sense. Policies that promote better chronic-disease prevention and management are smart investments.

The Centers for Disease Control and Prevention estimate that 80 percent of heart disease and type-2 diabetes cases, as well as 40 percent of cancers, are preventable. Making a dent in serious, costly diseases would make a significant difference in health-care spending. And if we make the investment in preventing these diseases, we should get "credit" for the savings.

Chronic diseases such as diabetes and heart disease are responsible for seven out of 10 deaths and affect more than 130 million Americans. The annual economic impact of the seven most common chronic diseases in the United States is estimated at $1.3 trillion, which could balloon to nearly $6 trillion by 2050.

There is a real opportunity before us to make a significant difference in the well-being of Americans and the economy. We should all pay attention to this important discussion in Washington and urge our federal representatives to do the same. This may be the last chance we get to achieve meaningful health-care reform for a long time.