BUTLER: Time for 'real world' health budgeting

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By Stuart Butler

OPINION/ANALYSIS:

What if Congress actually had to pay for any new program it wanted to start? It's a common-sense way to do business. And totally alien to Washington's breezy "spend now, find the money later" zeitgeist.

But there may be some hope after all. Despite getting Congress to pass trillions of dollars in new spending and debt since Inauguration Day, President Obama has established a welcome new principle for health care legislation.

He says it must be paid for. Not financed by borrowing today or in the future.

Sounds good. Of course, this being Washington, there's some fine print. Let's look at it closely so we know exactly what the Obama principle of paid-for health reform really means.

According to budget chief Peter R. Orszag, the president "is committed to the principle that health care reform must be deficit neutral over the next decade."

First, notice the careful reference to paying for the "next decade," not for the life of the program, which would be permanent.

This 10-years-only test is one way Washington routinely hides the long-term cost of a program. It simply ignores all downstream (after 10 years) liabilities.

It's like those credit card offers in the mail. "ZERO interest for 10 months!!!" Everything's fine until you hit month 11, and suddenly you're having to pony up the 18 percent interest from there on out. In Washington, it's a 10-year grace period. All costs after that are, to use budgeting parlance, "outside the budget window."

While congressional budgeteers may conveniently ignore such costs, they are very real, and can be staggering.