One of the most exasperating aspects of debate on health care reform is that the cost estimates cannot be trusted.

Democrats pointed out that the estimates come from the nonpartisan Congressional Budget Office.

Trouble is, the CBO can provide estimates only within the parameters of the bill as it is written.

In the case of the House reform bill, Democrats couldn’t make the numbers show that the bill would reduce the federal deficit. So they pulled physician Medicare reimbursements from the bill and passed them as a separate, unfunded piece of legislation that the CBO said would add $210 billion to the federal deficit over 10 years.

(Incidentally, if you were surprised when the American Medical Association endorsed the House reform bill, passage of the separate reimbursement legislation explains why.)

In reality, when the two bills are analyzed together they would add $89 billion to the federal deficit from 2010 through 2019, the CBO said recently in response to a request from a Republican congressman.

The Senate bill doesn’t use that particular trick with physician Medicare reimbursements, but it’s just as misleading. The bill assumes that the payment rates will be reduced by 23 percent in 2011. No one expects that to actually happen.

The Senate bill also has a number of other gimmicks so that it can appear to cut the federal deficit. For example, it would begin collecting premiums for a new long-term care insurance program right away. Benefits, however, would not start until 2016.

Sen. Kent Conrad, D-N.D., called the plan “a Ponzi scheme of the first order, the kind of thing that Bernie Madoff would have been proud of.”

The Senate bill does the same thing with fees and new taxes, starting collection months or years before the benefits begin.

The net effect over the 10-year period in the CBO analysis is to artificially inflate the revenue and minimize the expense, making it appear as though the reform plan was sustainable over the long term.

It should be noted that Republicans also used budget gimmicks when they controlled Congress. And, as the Journal Star editorial board has pointed out repeatedly, the Republican-controlled Congress passed the prescription drug benefit without any plan to pay for it. All those costs have simply been added to the federal debt.

Columnist David Broder reported (LJS, Nov. 24) that polls show Americans do not believe the claims that the reform legislation will reduce the federal deficit.

They’re right. The budget tricks that Congress foists on the public are reprehensible regardless of which party uses them.