Is the Public "Option" a Trojan Horse for a Single-Payer Plan?

“Someone once said to me, ‘This is a Trojan Horse for single-payer,’ and I said, ‘Well, it’s not a Trojan Horse – it’s right there! I’m telling you: we’re going to get there, over time, slowly.’” Jacob Hacker, professor of political science at Yale, and author of the basis of the healthcare "re-form" plan that Obama and Ds are selling. (Youtube video July 2008) [1]

The Trojan Horse story teaches us to beware of foes bearing gifts. Healthcare "re-formers" bring gifts to the people with today's healthcare "re-form" legislation. Professor Jacob Hacker denies any stealth in the gift of the public "option," since it's obvious to him that the public "option" will lead to socialized healthcare in the US. While acknowledging the inevitability of single-payer, Hacker is still careful with his terminology, using "single-payer" instead of "socialism". President Obama (D), politically constrained as Anita Dunn pointed out, can no longer even proclaim his professed goal of a universal single-payer plan.

So the President denies that the public "option" will lead to socialized healthcare. In a speech on June 11, 2009 at a town hall rally for healthcare "re-form" in Green Bay, WI, Obama disingenuously described R opposition to a public health insurance option in the healthcare re-form bill (video):

"It's not clear that it's based on any evidence, as much as it is their thinking, their fear that somehow once you have a public plan, that government will take over the entire healthcare system."

But it's not only Rs who see it as a step to socialized healthcare, "progressive" Paul Waldman, an advocate for socialized healthcare, explains in a December 23, 2008 American Prospect article:

"That isn't to say a public option is just a modified single-payer system. It would be one option among many for individuals and businesses, and would leave the private insurance system in place (you can read more on the benefits of the public option here). But it does crack the door open for expanding the number of Americans who get their health insurance through the government."

The Trojan Horse Strategy

While the President denies that the public "option" is a Trojan Horse for a single-payer healthcare system, what do other healthcare "re-formers" say?

Rahm Emanuel (D), the President’s chief of staff, "Mr. Don't-Let-a-Crisis-Go-to-Waste," clearly states how you are being lied to by the President in this video from June 17, 2009:

Socialized Healthcare Supporter: "Hey Rahm, why'd the President take single payer off the table? In 2003 he said he was for single-payer, now he's against it, why did he flip-flop?"

Emanuel: "Because it's just what I said in there. The objective is important, it's not the means."

Healthcare for America Now (HCAN) spokesman John Gaudette, speaking at a monthly meeting of the Progressive Democrats of America in May 11, 2009 outlines the strategy (at 3:00 in this video):

"...the public health insurance option is the thing to do because that's what's winnable. And you can make that strong enough and leave it to the American people to determine where this thing goes, its much easier to fix legislation when its created than to create something new, and that's something important to remember. This tension, this idea that we can hold out for something that's as grand and hopeful as we want tends to run counter to what's going on in DC."

In this one minute video, Gaudette, like Hacker and Emanuel, advises single-payer supporters to be patient, the public "option" will become single-payer. Gaudette credits congresswoman Jan Schakowsky (D) from the Illinois 9th district, part of the House D leadership, for pushing the public "option." Watch this video of Schakowsky speaking to advocates of single-payer healthcare on April 18, 2009, as she vehemently affirms the strategy:

"And next to me was a guy from the insurance company, who then argued against the public health insurance option, saying 'it wouldn't let private insurance compete, that a public option will put the private insurance industry out of business and lead to single-payer.' (audience cheers)

“My single-payer friends, he was right. The man was right... I know that many of you here today are single-payer advocates and so am I... Those of us who are pushing for a public healthcare option don't disagree with the goal. This is not a principled fight. This is a fight about strategy for getting there, and I believe we will.”

Wisconsin senator Russ Feingold (D) also confirmed the strategy of using this year's iteration of healthcare "re-form" as a Trojan Horse for a socialist single-payer system in an interview May 5, 2009 (video):

"I would love to see it, and I believe the goal here is to create whatever legislation we have in a way that could be developed into something like a single-payer system."

Single-payer proponent and congressman, Barney Frank (D), acknowledges that the public "option" is a Trojan Horse in this July 27, 2009 video:

Socialized Healthcare Supporter: "Don't you think we should scratch everything and start anew with single-payer?"

Frank: "No."

Socialized Healthcare Supporter: "Why not? ...Why shouldn't we start with single-payer anew?"

Frank: "Because we don't have the votes for it. I wish we did. I think, if we get a good public option, it could lead to single-payer, and that's the best way to reach single-payer. Saying you'll do nothing until you reach single-payer is a sure way to never get it..."

Socialized Healthcare Supporter: "Right now there's not a strong public option, is there?"

Frank: "We don't know what the plan is. I'm for a strong public option. I think your strategy is suicidal for trying to get the single-payer. The best way we're going to get single-payer, the only way, is to have a public option and demonstrate its strength and its power."

Health and Human Services secretary Katherine Sebelius now denies the public "option" is the path to socialized healthcare according to a June 2009 AP interview:

"The notion that a public option 'is really the stalking horse' for a government-run system 'is not accurate,' Sebelius said."

But Sebelius, like Obama in 2007, outlined the gradual path to single-payer universal healthcare in this 2007 video:

“I’m all for a single-payer system…eventually"

Our political doctors have slipped on their rubber glove, and while they may start with a finger, soon it will be a fist.

Remember, it's for your own good.

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[1] Patients United Now, “The Public Plan Deception—It’s Not About Choice” video: (accessed 24 Nov 2009 at http://www.youtube.com/watch?v=zZ-6ebku3_E )

Watch the video and decide what you think Hacker is saying. Hacker acknowledges that the public "option" will lead to single payer socialism while he shills for his brainchild (pdf). He supplies the talking points that "re-form" proponents use, and believes that Medicare, one of the reasons the Obama administration is so hot to regulate healthcare costs is working well:

"The idea of a public insurance plan goes back very far, and the Medicare program, of course, embodies that ideal. In 1965, the United State decided that for America's elderly, and later for America's disabled, there would be a public health insurance plan available regardless of income or medical conditions. And that plan is enormously popular today, to the point that many Americans, it seems, aren't fully aware that it's a government insurance plan, because it works so well they just can't believe the government actually gets things right."[2]

Hacker says he was taken out of context in footnote 37 of PUBLIC PLAN CHOICE IN CONGRESSIONAL HEALTH PLANS: THE GOOD, THE NOT-SO-GOOD, AND THE UGLY, By Jacob S. Hacker, Ph.D., Aug 20, 2009, (accessed 24 Nov 2009 at http://www.metaglyfix.com/jsh/pdfs/Hacker_Public_Plan_August_2009.pdf):

"However, when a small firm decides to purchase coverage through the exchange, they are in effect buying group health insurance for their workers. If firms believe their workers would have access to better options through the exchange, why should they not be able to buy coverage for their workers through it? After all, employers who enrolled their workers in the exchange would have to pay the same share of the premium that they would have to pay if they purchased coverage outside the exchange, so the main attraction of going into the exchange for employers would be to obtain better value group health plans, including the public plan.37"

"37 Lately, comments I made at a 2008 forum have been taken out of context to suggest that public plan choice is a stealth strategy of eliminating private insurance. This is nonsense: I developed the public plan idea as an alternative to “Medicare for All” (see Hacker, Jacob S., “Fixing the Left’s Health Care Prescription,” Slate, 10 October 2006, accessed at http://www.slate.com/id/2151269/?nav=tap3), as well as a competitive alternative to private insurance that would compete on a level playing field with private plans within a new national insurance exchange (see Hacker, supra note 6). I do not believe that a new public plan will evolve into a single payer system. My aforementioned comment at the 2008 event was that the new public plan is not a hidden “Trojan Horse.” The public plan is right out in the open, as it should be, since most Americans say they want the choice of a new public plan. While I believe that we should move over time toward a system in which lower-wage workers and the employees of small firms—who are not served or ill-served by the private market today—have access to a more stable set of public and private insurance options, I have always contended that most higher-wage workers and large employers will continue to be covered by employment-based plans. As I wrote in my proposal, “The main reason why Health Care for America is comparatively inexpensive [with regard to new federal spending] is that higher-wage and larger employers would continue to offer qualified coverage privately. For large employers with higher payrolls, private employment-based coverage would remain a good deal—especially since this proposal would not eliminate the tax-favored status of private coverage. For employers not enjoying the administrative economies of large-group purchase or with lower payrolls, the Health Care for America Plan [offering the new public plan and private plans] would be the better option. Thus, most of the new federal spending would be targeted on those firms and workers least capable of providing or obtaining insurance today.” (Hacker, Jacob S., “Health Care for America,” EPI Briefing Paper #180, 11 January 2007, accessed at http://www.sharedprosperity.org/bp180.html.)"

[2] "Inventor of the public option explains why it's crucial," Alex Koppelman, Salon, September 9, 2009, (accessed 24 Nov 2009 at http://www.salon.com/news/feature/2009/09/09/public_option/index.html).

Liars, Damned Liars, and Politicians (Part 3)

"The ability for elected officials to say things that are untrue, and I would say the ability to say one thing to one audience, and another thing to another audience has ended... There is no such thing as off the record. There is no such thing as a 'closed to press' meeting. Anybody with a cell phone can pick up the video.

"Senator Obama himself learned that when he told a fundraising group in San Francisco in March... He made some comments about people who owned guns in small communities that ended up, of course, costing us a lot of votes in rural Pennsylvania... Anything you say you should expect to be on Youtube...

"The premium for what ... I might just call being honest is much higher than it used to be: that what people could get away with even 4 years ago isn't going to happen." Anita Dunn, White House communications director for the first year of the Obama administration, speaking at a Jan. 12, 2009 event in the Dominican Republic on Obama's media tactics. (Minutes 4:40-6:32 of Youtube video)

Anita Dunn reminisces about the lost "ability for politicians to say things that are untrue" or more precisely, "to say one thing to one audience and another thing to another audience." What? Politicians lie?

Dunn acknowledges a premium for a politician speaking truthfully. Robert Reich (D) alluded to the same phenomenon in his September 26, 2007 speech at Berkeley, where he listed the goals of government-run healthcare.

According to Dunn, politicians can't "get away with" being honest about their goals any more. She even notes how her politician, Obama (D), unfortunately found he could no longer speak so truthfully in public settings. In Obama's case, he revealed his distaste for small town gun owners and people who "cling" to religion out of frustration (Youtube video).

The premium to politicians for revealing the true goals of their policies to the people is that those politicians might not get to inflict their visions on anyone. To paraphrase Lincoln, you can fool all of the people some of the time, but you can't fool anyone if you actually tell them the truth about your plans for them. Imitating a doctor or nurse, but on a grander scale, politicians pretend they're saving the world with their "re-forms," lying to you that "it won't hurt a bit," right until they jab the needle in. Healthcare "re-form" will hurt, but according to the politicians, it's for our own good, so it's ok for them to lie; we can thank them later.

Politicians know what's best for us--just ask them.

Obama and the Public "Option"

On August 11, 2009 in Portsmouth, N.H., in his pursuit of healthcare "re-form," the President carefully made "a distinction between a universal plan versus a single payer plan" (video):

Q: "Mr. President, you've been quoted over the years -- when you were a senator and perhaps even before then -- that you were essentially a supporter of a universal plan. I'm beginning to see that you're changing that. Do you honestly believe that? Because that is my concern. I'm on Medicare, but I still worry that if we go to a public option, period, that the private companies, the insurance companies, rather than competing -- because who can compete with the government; the answer is nobody. So my question is do you still -- as yourself, now -- support a universal plan? Or are you open to the private industry still being maintained?"

PRESIDENT: "Well, I think it's an excellent question, so I appreciate the chance to respond. First of all, I want to make a distinction between a universal plan versus a single-payer plan, because those are two different things.

"A single-payer plan would be a plan like Medicare for all, or the kind of plan that they have in Canada, where basically government is the only person -- is the only entity that pays for all health care. Everybody has a government-paid-for plan, even though in, depending on which country, the doctors are still private or the hospitals might still be private. In some countries, the doctors work for the government and the hospitals are owned by the government. But the point is, is that government pays for everything, like Medicare for all. That is a single-payer plan.

"I have not said that I was a single-payer supporter because, frankly, we historically have had a employer-based system in this country with private insurers, and for us to transition to a system like that I believe would be too disruptive. So what would end up happening would be, a lot of people who currently have employer-based health care would suddenly find themselves dropped, and they would have to go into an entirely new system that had not been fully set up yet. And I would be concerned about the potential destructiveness of that kind of transition. All right? So I'm not promoting a single-payer plan."

The President wanted to make a distinction between a universal plan and a socialist single payer plan because he pretends that one will not lead to another. He says he is not "promoting" a single payer plan, but we do know he is "a proponent of a single payer universal healthcare plan" as he said in 2003 in this video of his speech to an AFL-CIO group during his US Senate campaign:

“I happen to be a proponent of a single-payer universal health care plan.”

As late as 2007, then Senator Obama was advocating a gradual move to a universal single-payer healthcare plan. Forty seconds into this May 2007 video of then Senator Obama during his campaign for President, he described how the US could gradually be moved to a single payer plan:

“But I don’t think we’re going to be able to eliminate employer coverage immediately. There’s going to be potentially some transition process — I can envision a decade out, or 15 years out, or 20 years out...”

Why do you think they call it "single payer" and not socialism?

Today the President says he wants only mandatory universal healthcare, not single-payer. The proposed mandatory universal healthcare includes a curiously named public "option." The public "option" will be mandatory--if you don't have healthcare insurance, the government will force you to buy it. President Obama is not telling Americans that he ultimately wants universal single-payer healthcare because healthcare "re-form" would not pass in Congress if he advocated socialism directly. Most Congressional "re-form" supporters pretend for the public that individual Americans will still be in control of their healthcare after healthcare "re-form" legislation passes. "Re-formers" are rushing to pass legislation in Obama's first year because of the fleeting nature of political capital.

As Anita Dunn said, pols can't be "honest" with Americans about their real vision for America; no longer can a politician "get away with" what they could just four years ago. Dunn is right, and President Obama has learned his lesson: he can no longer pay the premium for honesty. The President is lying because he thinks he knows what's best for Americans. Remember: it's for your own good, it won't hurt a bit, and you'll be thanking them later.

Or will you?

Liars, Damned Liars, and Politicians (Part 2)

OBAMA: Now there are also those who claim that our reform efforts would insure illegal immigrants. This too is false. The reforms I'm proposing would not apply to those who are here illegally.

WILSON: You lie.

OBAMA: That's not true. From an exchange during President Obama's speech before a joint session of Congress September 9, 2009

Was Joe Wilson (R) right? Did Obama (D) lie? Decide for yourself.

"Raul Grijalva, an Arizona Democrat, said Hispanic lawmakers got a pledge from leaders to defeat any Republican attempt to insert language to bar undocumented immigrants from exchanges." From Bloomberg article "Democrats Seek Votes on Health-Care as Delay Possible (Update1)" the day before the US House passed healthcare "re-form" legislation HR 3962 by a vote of 210-205.

Representative Wilson's rudeness during President Obama's speech to Congress on healthcare "re-form" drew attention to the messenger. But what about Wilson's message? President Obama promised his healthcare "re-forms" wouldn't apply to illegal aliens, so why was it so important to Hispanic lawmakers that D-leaders pledge to defeat any language that barred illegal aliens from the health insurance exchanges?

On November 7, 2009, the House passed the largest expansion of the nation’s healthcare system since the 1965 creation of Medicare.[1] The Congressional Budget Office estimate for HR 3962 (CBO estimate pdf) predicted:

"According to CBO and JCT’s assessment, enacting H.R. 3962 would result in a net reduction in federal budget deficits of $109 billion over the 2010–2019 period (see Table 1). In the subsequent decade, the collective effect of its provisions would probably be slight reductions in federal budget deficits. Those estimates are all subject to substantial uncertainty.

"The estimate includes a projected net cost of $891 billion over 10 years for the proposed expansions in insurance coverage. That net cost itself reflects a gross total of $1,052 billion in subsidies provided through the exchanges (and related spending), increased net outlays for Medicaid and the Children’s Health Insurance Program (CHIP), and tax credits for small employers; those costs are partly offset by $167 billion in collections of penalties paid by individuals and employers."

Statistics and Illegal Alien Demographics

Only in Washington, D.C. can a bill projected to cost more than $1 trillion over 10 years be considered to reduce the budget deficit over the same time period by $109 billion. To do the equivalent on a small scale, you'd have to plan to buy a yacht while you're millions of dollars in debt, buy a speedboat instead, and then tell your family you're saving lots of money because you didn't buy the yacht.

Notice also how the CBO estimate (see Table 3 of estimate) counts $168 billion in penalties paid by individuals and employers as income. House Ways and Means Committee Member Dave Camp (R) released a letter (pdf) from the non-partisan Joint Committee on Taxation (JCT) confirming that failure to comply with the mandate in HR 3962 for individuals to buy health insurance would land people in jail. People who do not maintain “acceptable health insurance coverage” and do not to pay the bill’s new individual mandate tax (generally 2.5% of income), are subject to numerous civil and criminal penalties, including criminal fines of up to $250,000 and imprisonment of up to five years.

The CBO is so certain that this onerous bill will oppress people and that many will try to avoid complying with it, that its budget estimate includes future penalties. Adding penalties as income to the estimate lets the CBO pretend HR 3962 costs even less than everyone knows it will. Congress is depending on people breaking the law, so they made it painful enough to force many people to break it. This lets the CBO publicize that the inevitable penalties collected are not an increase in taxes.

If Congress makes it illegal to breathe and collects penalties when people do what it takes to survive, they could subsidize lots of programs while bragging that taxes were low.

Magic and misdirection while the crowd cheers for more.

Federal bureaucrats also plan for illegal aliens to help pay for the extra costs through FICA taxes. The 2009 Annual Report by the Board of Trustees for Social Security and Medicare uses illegal aliens in their estimates of the future costs of Social Security and Medicare.[2] The federal government has no incentive to stop illegal border crossings because it depends on enough people crossing the border illegally to help pay for Medicare and Social Security. Actuaries count illegal aliens favorably in their calculations of future program costs.[3]

Paying Off the AMA

Is Obama lying about anything else?

The AMA usually opposes changes in the status quo. But this time the AMA supports healthcare "re-form" because it was bought off (pdf) with promises of change to the Medicare Sustainable Growth Rate (SGR) payment system for physicians. Without a change to current law, SGR Medicare payments to doctors are scheduled to be cut 21.5 percent as of January 1, 2010, and by an additional 5.5 percent each year from 2011 through 2014, with another small reduction in 2015.[4] Typically, Congress--under both D and R leadership--routinely prevents the cuts from taking effect for a year or two at a time. But House and Senate leaders have always left intact the underlying requirement to keep doctor payment below the rate of GDP growth.[5]

To get AMA support, healthcare "re-formers" promised to end for the next ten years the annual question of whether the SGR Medicare payment cuts will go into effect . To do that, "re-formers" must commit to spending an additional $247 billion on healthcare. The problem for "re-formers" is this impacts the perceived cost of healthcare "re-form." President Obama had initially targeted the cost for "re-form" at $900 billion over 10 years. Adding the $247 billion to the healthcare "re-form" legislation obviously puts the cost at over trillion dollars.

Healthcare "re-formers" tried to hide the bribe to the AMA. They didn't want it tabulated in the CBO estimate for what healthcare "re-form" legislation would cost. A separate $247 billion Senate measure, S.1776, the Stabenow bill, would have imposed a 10-year freeze on mandated cuts in Medicare payments to doctors. Rs defeated S.1776 on October 21, 2009, signaling the House that it would have to bury some of that money in the House version of healthcare "re-form": HR 3962.

On November 7, 2009, the House passed an amendment to HR 3962, HR 3961, which did just that. HR 3961, the Medicare Physician Payment Reform Act of 2009, amends title XVIII of the Social Security Act to reform the Medicare SGR payment system. HR 3962 exceeds the $900 billion cost target by approximately $200 billion: the CBO estimates it will cost $1.1 trillion over 10 years.

As for the Senate, Alexander Bolton writes in The Hill:

"A senior Democratic senator who spoke on condition of anonymity said the defeat of Stabenow’s bill could have reverberations, but only if Democratic leaders fail to assure doctors groups that that they will find another way to avert cuts in their Medicare reimbursements, which are mandated by a 1997 budget law."

Candidate Obama vowed he'd be open with the American people (video). President Obama has not kept his promise, making backroom deals with the AMA and planning for continued use of taxpayer resources for illegal aliens.

Wilson told Obama: "You lie."

Is it true? You decide.

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[1] HR 3962 was 1990 pages (pdf) before amendments were added. The Senate is considering a similar bill.

[2] The Social Security Act requires that the Board, among other duties, report annually to the Congress on the actuarial (financial) status of the OASI and DI Trust Funds. The 2009 annual report, "THE 2009 ANNUAL REPORT OF THE BOARD OF TRUSTEES OF THE FEDERAL OLD-AGE AND SURVIVORS INSURANCE AND FEDERAL DISABILITY INSURANCE TRUST FUNDS" is the 69th such report.

The Board of Trustees was established under the Social Security Act to oversee the financial operations of the OASI and DI Trust Funds. The Deputy Commissioner of the Social Security Administration (SSA) is designated as Secretary of the Board. The Board is composed of six members:

• Four members serve by virtue of their positions in the Federal Government: the Secretary of the Treasury, who is the Managing Trustee; the Secretary of Labor; the Secretary of Health and Human Services; and the Commissioner of Social Security.
• The other two positions, which are currently vacant, are for members of the public, to be appointed by the President, subject to confirmation by the Senate.

[3] THE 2009 ANNUAL REPORT OF THE BOARD OF TRUSTEES OF THE FEDERAL OLD-AGE AND SURVIVORS INSURANCE AND FEDERAL DISABILITY INSURANCE TRUST FUNDS, V. ASSUMPTIONS AND METHODS UNDERLYING ACTUARIAL ESTIMATES, at http://www.ssa.gov/OACT/TR/2009/trTOC.html (November 10, 2009)

In the "2009 OASDI Trustees Report," illegal immigration is considered as "Other Immigration," in contrast to legal immigration. In Section V ASSUMPTIONS AND METHODS UNDERLYING ACTUARIAL ESTIMATES, Part 3 Immigration Assumptions, illegal immigration helps the calculation by adding to the number of taxpayers paying Social Security and Medicare taxes:

"Other immigration consists of immigrants who enter the Social Security area in a given year and stay to the end of that year without having LPR status, such as undocumented immigrants and temporary foreign workers and students.

...

"Combining the annual legal immigration and emigration assumptions results in ultimate net legal immigration of 750,000 persons per year under the intermediate alternative. For the low-cost and high-cost scenarios, ultimate annual net legal immigration is 960,000 persons and 560,000 persons, respectively.

"The number of other immigrants residing in the Social Security area population is estimated to have been about 9.7 million persons as of January 1, 2000, increasing to about 12.8 million persons as of January 1, 2006. This other-immigrant population is highly mobile and far more likely to leave the Social Security area than is the native-born or legal-immigrant population. The average number of persons entering the other-immigrant population in the period 2000 through 2006 is estimated to have been about 1.5 million per year. During the same period, the number of other immigrants who left the Social Security area or adjusted status to become LPRs is estimated to have averaged about 960,000 per year. Thus, annual net other immigration during this time period is estimated to have averaged approximately 540,000 persons.

"For the intermediate assumptions, annual other immigration is assumed to continue at the level of 1.5 million persons throughout the projection period. For the low- and high-cost scenarios, future annual other immigration is assumed to average 1.8 million persons and 1.2 million persons, respectively.

"Emigration from the other-immigrant population includes those who leave the Social Security area and those who adjust status to become LPRs. The annual number of other immigrants who leave the Social Security area is estimated based on modeled departures, disaggregated into two groups, for the period 2000-06. The first departing group is set at fixed annual numbers of departures, by age and sex, which remain constant throughout the projection period. This first group is directly related to the number of other immigrants that are assumed to have recently entered the Social Security area. The second departing group is calculated by applying a set of annual departure rates, by age and sex, to the other-immigrant population in the Social Security area. In addition, the annual number of other immigrants who adjust status to become LPRs is assumed to ultimately be 500,000 for the intermediate assumptions. This level is one third of the annual number of other immigrants assumed to enter the Social Security area. For the low- and high-cost scenarios, ultimate annual numbers adjusting status to LPR are assumed to average 600,000 persons and 400,000 persons, respectively.

"Under the assumptions and methods described above, the size of the other-immigrant population is projected to grow substantially. This growth reflects the excess of annual other immigration over the combined annual numbers of emigrants and deaths that occur within the other-immigrant population.

"Net other immigration decreased from a level averaging over 590,000 per year in the period 2000 through 2003, to about 465,000 in 2006, reflecting an increase in the number of other immigrants adjusting to LPR status as a result of the effort to reduce the backlog of applications for LPR status. By 2010, when the backlog of applications is expected to be eliminated, net other immigration is projected to be about 440,000 persons per year. After 2010, net other immigration is projected to decline steadily to about 275,000 in 2063 and to remain fairly stable thereafter. The decline in net other immigration is attributable to the increasing number of other immigrants residing in the Social Security area. This results in an increase in the numbers who emigrate out of the area based on the rates of departure described above. All other components of other immigration and emigration are set at fixed levels after 2010, and thus do not contribute toward any change in net other immigration. The average annual level of net other immigration over the 75-year projection period is about 315,000 persons. Net other immigration is estimated to average about 410,000 persons per year under the low-cost assumptions and 220,000 persons per year under the high-cost assumptions.

"The total level of net immigration (legal and other combined) is estimated to average 1,065,000 persons per year during the 75-year projection period under the intermediate assumptions. For the low-cost assumptions, total net immigration is estimated to average 1,370,000 persons per year. Under the high-cost assumptions, total net immigration is estimated to average 785,000 persons per year.

"Demographers express a wide range of views about the future course of immigration for the United States. Some, like the 2007 Technical Panel mentioned in the previous section, believe that immigration will increase substantially in the future. Others believe that potential immigrants may be attracted to other countries or that the U.S. borders could be tightened in the future."

[4] 2009 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds, May 12, 2009, p. 22, at http://www.cms.hhs.gov/reportstrustfunds/downloads/tr2009.pdf (September 24, 2009).

[5] The Baucus Health Bill: A Medicare Physician Payment Shell Game, by Dennis G Smith, September 25, 2009, at http://www.heritage.org/Research/healthcare/wm2629.cfm (November 10, 2009)