PharmExec Blog

Elmendorf Refuses to Go Quietly Into the Night of HCR


Guest Blog by Tom Norton of NHD Smart Communications. You can reach him at

Amidst all the gurgling of oil last week(bad! bad! bad!), a competing thunderstorm of words erupted as Doug Elmendorf, Director of CBO, had the temerity to revisit the real costs of the new HCR law. Addressing something that, for whatever reason, this lifelong Hill bureaucrat  just couldn’t get done about eight weeks ago as the bill was coursing its way through Congress, the leader of the CBO came clean and spoke his mind. (Do remember that Mr. Elmendorf had been unceremoniously called to the White House in July 2009 during the heat of the HCR debate to “get his facts straight”, personally, with President Obama. So maybe this simple, short PP was a little bit of payback?)

Whatever, to his everlasting glory, Mr. Elmendorf screwed up his courage on May 26th and pronounced the following official OMB view on costs associated with the newly passed Obamacare: “Rising health costs will put tremendous pressure on the federal budget during the next few decades and beyond. In CBO’s judgment, the health legislation enacted earlier this year does not substantially diminish that pressure.”  Check it out. The deck’s simplicity and clarity are killer. Put another way,  Mr. Elmendorf felt constrained to suggest that the U.S. cannot spend money it does not have.  Indeed, in a none too subtle fashion, he comes very close to suggesting that Obamacare is an exercise in ‘Mad Hatter’ math (See, in particular, Slide #13).

Peter Orzag, former CBO director, and now Director of the Obama Office of Management and Budget was apparently stunned, as, it seems, was the entire Administration.  The slide deck circulated all over Capitol Hill for one week before Orzag, on June 2nd, issued this tardy retort to Elmendorf’s OMB bombshell: “The Act (Obamacare) has the potential to fundamentally transform our health system into one that delivers better care at lower cost. This potential isn’t fully captured in CBO’s numbers…” Whoa.  Case closed, huh?

Even more surprising is that once this first strafing run by Elmendorf was over, and on the same day that Orzag released his lame response to CBO, none other than the New York Times unloaded with both barrels presenting a front page story suggesting that the much praised and oft referred to Dartmouth Atlas of Health Care, widely quoted during HCR battle as the defining  study that declared that all health care everywhere should cost about the same, and that in particular, ‘cheaper care was better care,’ was, well, skewed…Or so said the NYT.

And once again a shocked Peter Orzag responded lamely, this time to the NYT article, stating, “I do not rely on the Dartmouth Atlas alone to prove that huge savings are possible in HCR.”  Enough said.

So let us review.  In the course of one week, we learned that:

A. The new law that is supposed to cost less and give us more, very likely won’t, courtesy of Mr. Elmendorf.

B. The primary study that led to the widely held view that cheaper care is better care during the HCR debate, is wrong, courtesy of the New York Times.

Leading us where?

Well let’s take the last point, first. In considering what the NYT was up to with their expose of the Dartmouth Atlas, I honestly have no answer. Do you get it? I was personally amazed that the publication went all out in its attack on the Administration and still am befuddled as to exactly what was going on there. If you tell me it was journalistic ‘fairness’ at work, fine. But LOL.

In the case of Elmendorf, however, seems to me that sometimes people just need to make a clean breast of things.*  For the last year, it’s been pretty obvious that his nominally Democratic political future is over. Really, has been since his CBO “scoring” single handedly derailed the entire HCR show for several weeks last summer when he found the Senate’s version of the bill was a trillion dollar, plus, budget buster… So, this spring he knew exactly what he was doing and seems to me, he had just decided he wouldn’t go quietly into the night given what he knew was the fiscal enormity of this new law.  And, as a result, I frankly doubt we’ll be hearing a lot more from Doug Elmendorf at CBO. Too bad.

That’s my Point of View. What do you think?

* ‘Make a clean breast of it’ is a suggestion that the ‘breast’ is the seat of the one’s emotions and secrets; one’s ‘heart’. To disclose this openly was to clean one’s heart of impurity.

This column was originally published on The Norton Point of View on the NHD Smart Communications website, and is available for download there.  The opinions expressed in the Norton Point of View are solely those of Tom Norton and do not represent the position of NHD Smart Communications and Advanstar Communications.

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  1. Paul Handel
    Posted June 11, 2010 at 11:10 am | Permalink

    This Administration’s bloviating about PPACA brings to mind an A.Lincoln story. During a debate Mr Lincoln asked: “how many legs does a dog have if you call a tail a leg? He answered his own question, “four”. “Calling a tail a leg doesn’t make it so”. No matter how often PPACA is touted, it does nothing that it theoretically was enacted to do. It is a travesty and economic tragedy.

  2. Posted June 15, 2010 at 11:59 pm | Permalink

    He answered his own question, “four”. “Calling a tail a leg doesn’t make it so”. No matter how often PPACA is touted many more infomation & this site is good…………..
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