Health reform budget neutral?

The Congressional Budget Office has said that the net effect of health reform, based on their analysis, will be budget neutral. Many, upon hearing this, are raising their eyebrows and saying "seriously?"

Paul Levy wrote about this yesterday (click here), speculating that the implementation delay is intentional by the Obama administration... pushing the politically charged work out past the next Presidential election cycle. Here are a few other items worth considering:

• The proposed independent Medicare Advisory Board will recommend changes in Medicare reimbursement with limited Congressional oversight. Recommendations impacting hospitals or physicians are off the table through 2019. Expect other providers to be hit hard.
• Between 1 and 2% of hospital Medicare payments will be subject to quality and efficiency targets. Will the savings generated here be enough to offset the higher costs of the overall program? Payments to physicians could be altered based on utilization patterns, but the potential for that will be impacted by the usual process and it will take more political will than government leaders have been able to muster thus far.
• Accountable Care Organizations (ACOs) are introduced, but the currently fragmented system makes implementation difficult. If ACOs become hospital dominated systems, one has to wonder whether hospital systems will be able to effectively take the lead in driving costs down.

There's plenty to like about the proposed health reform legislation... and plenty to be worried about as well.