Next week, the House of Representatives is scheduled to take up a bill (H.R. 3961) which would enact a permanent “fix” to the unquestionably flawed Medicare physician payment update formula. The Congress created a formula for physician Medicare payment that would automatically cut doctor payments, but has routinely acted to prevent its own handiwork from going into effect each year. So, under current law, any permanent fix would sharply increase Medicare spending.

According to the Congressional Budget Office (CBO), the bill would cost an additional $210 billion over the next ten years. In fact, the measure was originally included in earlier versions of the House health care bill , but it was later carved out of the legislation in order to reduce bill’s ten year cost and make the Congressional leadership’s health care agenda appear more fiscally responsible than it is. The Senate leadership tried to pull a similar stunt a couple of weeks ago, got called on it in the press, and the ploy failed.

The Congressional leadership has been trying every budget gimmick in the book to disguise the true cost of their health care agenda. One of the major tricks is to latch onto their health bills’ net cost instead of its gross cost after a full ten years of spending. Under the House legislation, for example, the taxes are front-loaded, but the heaviest spending is back-loaded, so, on paper, budget scorekeepers show lower costs and less of an impact on the federal deficit in the first ten years than they otherwise would.

But pulling billions of dollars in new spending from the health care legislation — intending to pass those provisions separately without paying for them— is perhaps the biggest trick that Congressional leaders are trying to play. As noted, Senate Democrats –under the leadership of Senator Reid– thought they could pass the “doc fix” (to prevent cuts to doctors’ Medicare reimbursement rates) while adding billions to the deficit before voting on a larger health care reform package. It failed. Republicans and 13 moderate Democrats weren’t going to let the Senate impose even heavier burdens on current and future generations of taxpayers.

Now, after the passage of its Godzilla-like health care bill (H.R. 3962) this past weekend, the House of Representatives will soon become center stage for the attempt at the same type of Senate-style deficit-increasing deception. As noted, the CBO estimates that the “doc fix” in the House bill (HR 3961) would cost taxpayers $210 billion in the first ten10 years Since this would be an increase in the cost of services in Medicare Part B services, the part of Medicare that pays doctors, it would also mean an increase in seniors Medicare Part B premiums. In its November 4, 2009 budget estimate of H.R. 3961, CBO estimates that over the period 2011 to 2019, Medicare Part B premiums would increase by $49 billion.

These ten year costs, of course, are only the tip of the proverbial fiscal iceberg. The year-by-year costs accumulate over time. Assuming that the House does not provide for permanent offsets- other spending cuts- to cover the additional Medicare spending for the “doc fix”, the impact would be enormous—potentially adding trillions more to Medicare’s already massive long-term unfunded obligation.

Co-authored by Greg D’Angelo.