Two Problems

According to the Wall Street Journal health care legislation faces two serious problems in Congress. What to do and how to pay for it.

Two pressure points are emerging in Congress's rush to pass health-care legislation by the August break: how to pay for the package and whether to create a new public health-insurance plan.

Douglas Elmendorf, director of the Congressional Budget Office, said Monday his office has given lawmakers a "tremendous quantity of numbers" as they weigh how much it will cost to extend coverage to millions of uninsured Americans and how much revenue will be raised by proposed tax increases.

The nonpartisan office's numbers are critical because they are the basis for determining a bill's price tag, and whether, as President Barack Obama has promised, the plan won't increase the budget deficit.

"Is it every number they want?" said Mr. Elmendorf. "No. Because every number they get, you then think of four ways to tweak it."

Lawmakers are getting closer to unveiling sweeping changes that would reshape taxes, health insurance and coverage for the 46 million people in the U.S. who don't have it.

As soon as this week, a Senate committee is expected to release the first piece of legislation, with a second bill to follow later this month. The House is expected to unveil its health bill by the middle of the month. Both chambers are aiming to pass legislation by August and deliver a single bill to Mr. Obama by October.

The legislation is expected to create federal- or state-run exchanges where consumers can comparison shop for health-insurance plans. Low-income Americans would get tax credits or other help to buy insurance, and the government would spend more to prevent chronic disease.

Since government has gotten into the health care industry, health care inflation has gone from an outrageous 5% a year to a more modest 10% a year. I think the new system could get that down to 15% or 20% with the right rules and incentives.