Running the Numbers on Health Reform
Since the 1960s, America's policymaking system has transitioned from one in which leaders like Lyndon Johnson could simply disparage the concept of budget projections to one in which policymakers consciously manipulate cost estimates. Paradoxically, the very safeguards put in place to thwart economically unsound legislation now cause chaos by incentivizing the development of flawed, even blatantly unworkable, policies. As Robert Saldin shows in When Bad Policy Makes
Good Politics, the pathologies of the new system are illustrated by the Community Living Assistance Services and Supports Act and its role in aiding passage of President Obama's landmark health reform
law. CLASS was supposed to bring much needed relief of America's dysfunctional long-term care system, but critics argued that its flawed design rendered the program unviable. However, what appeared to be a naïve proposal was actually a carefully framed policy designed to fit the rules of the game, particularly the Congressional Budget Office's cost-projection process. Although CLASS was destined for a "death spiral" requiring massive government bailouts, the CBO estimated it would save
tens of billions of dollars. These official "savings" made CLASS an appealing add-on to the Affordable Care Act. But when the Obama administration later announced that CLASS was impossible to implement,
America's long-term care system was left in crisis. This skillful examination of CLASS and the machinations of Congress provides insight into how the contemporary policymaking process really functions.