Transparency v. PAYGO in Health Reform Legislation

One of the looming questions for health reform legislation in the 111th Congress is how will it be paid for?  Or will that be less of a concern because deficit spending in a recession is deemed to be OK?

In earlier times, (i.e., 1990s), the projected costs of legislation had to be “paid-for” under the so-called PAYGO rules – which stands for “pay-as-you-go.”  However, in recent years those rules have lapsed or been waived.

Three recent nuggets of information indicate that transparency in the legislative process may be replacing PAYGO in the coming years.  First was the Obama Transition Team’s extra-ordinary level of transparency, exemplified by their policy of having information from all meetings with outside groups being posted on the web site – see news story and Transition Team Memo.  The second transforming event was the Transition’s Health Policy Team calling for people to have community discussions about health reform and to provide feedback to the Transition Team.  Both of these initiatives illustrate the game-changing nature of the internet on the public’s engagement in policy development.

The third piece of information was an interview in National Journal with US Representative Lynn Woolsey (D-CA), who co-chairs the Congressional Progressive Caucus.  The interview didn’t specifically address health reform, but her answer to a question about how Congress should deal with the costs of the stimulus legislation may be very illuminating as to how the costs of health reform legislation will be handled:

NJ: “Do you think that Congress should pay for the stimulus package with cuts elsewhere in the budget under the “pay-as-you-go” rules, or should the package include any other measures of fiscal discipline?”

Woolsey: “One element that would have to be there is transparency, in anything we do.” … “So no on pay-go. But it has to have transparency, and our investment has to be based on improving the situation for the average American – not just the wealthy banker.”

While transparency in all forms will certainly be very important for explaining the substance and process of health reform to the American people, it still presents a huge communications challenge because both the substance of health reform and the legislative process are so inherently complex.  Hopefully, these efforts will go a long way to changing the public’s dialogue about health reform.

And on a personal note, when I talk with individuals and groups about health reform,  perhaps these transparency and informational efforts will also help reduce the number of times I hear the phrase, “I just don’t understand why they don’t………..” which is usually then followed by a very well intentioned, but overly-simplistic, solution to our healthcare system’s problems.  While these statements do provide what educators call a “teaching opportunity,” moving the debate forward in a more wholesale fashion will certainly be a good thing.

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