[Breaking: We'll be liveblogging today's House hearing/markup on its reform bill. Here's the link to the hearing.]

There’s been some concern about why the House reform bill — America’s Affordable Health Choices Act — delays availability of the public plan until 2013.

But to understand that better, you need to spend a few minutes watching any of the cable "news" shows, and especially Fox News, as they discuss the various health care reform proposals.

In short, it’s about the taxes, and the fact that Fox News doesn’t care that 18,000 people die each year from lack of insurance converage.

I had just watched President Obama’s Rose Garden news event on MSNBC, saw Andrea Mitchell then turn to Pat Buchanan for comment !!! and then over to Fox News to see a deliberately uninformed anchor interview Marsha Blackburn and Rep. Yarmouth. Yarmouth did his best to correct the Fox anchor and Blackburn and explain what the bill actually does, and Blackburn did her best to flat out lie about it. The anchor was both duplicitous and clueless. And that’s what we’re in for.

All the anchor wanted to talk about was that terrible tax increase on the "so called wealthy" ($350,000/year doesn’t quality) and "so called super rich" ($1 million just doesn’t go as far as it used to). A later interviewee worried about the guy who operates the hot dog stand on the corner outside the NYSE, who will get wiped out by the Democrat’s new taxes.

You would never know from the cable news coverage that the House and Senate HELP Committee bills will end hateful and fraudulent insurer policies like rescission, denial for previous conditions and other forms of discrimination. Nor would you learn that tens of millions of uninsured people will gain coverage, that under-insured people will be protected with stronger basic plans.

And those reductions in Medicare payments? You won’t hear about reducing the cost of people currently ininsured and improving payment incentives; no, they’re about reducing care and services for Medicare patients — we’re going cheat older people out of Medicare!!! It’s an absolute lie, but get used to hearing it.

And never mind the misinformation about the public plan. Marsha Blackburn just made up stuff on that, based on a completely different plan in Tennessee which I have no doubt she also misrepresented.

So why do the current bills start the public plan no sooner than 2013 and phase in eligibility? As Eza Klein noted, the driving force is the need to keep the CBO rating at or below about $1 trillion over ten years, and the current House bill hits that goal pretty close.

Here are the tradeoffs: People who leave their current insurance (e.g., at work) and instead choose an insurance plan on the exchange are entitled to federal subsidies to help pay the premiums. If you stay with your employer, there are not additional subsidies beyond the current exclusion of health benefits from taxes. That means if 130 million Americans move from non-insured or insured at work to plans on the exchange, including the public plan, the cost of the subsidies could be huge, if a substantial number of those people were low-to-moderate income.

So to limit the initial 10-year hit on the budget, the House (and Senate) bills deliberately include several features to keep the initial budget impact to the arbitrary $1 trillion over ten years. I see several such features:

1. Schedule the exchange (and the public plan option) for 2013. It’s conceivable this could be open sooner, but that would just increase the initial 10-year budget impact.

2. In the first year, limit eligibility for the exchange (and public plan) only to those who are currently uninsured or to employees of small businesses (10 or fewer employees)

3. In the second year, raise eligibility slightly to small businesses with 20 or fewer employees

4. In subsequent years, give the Secretary of HHS discretion to expand eligibility to larger businesses, as the exchange (and public plan) gain experience/ability to expand.

There are other details, such as use of Medicare providers (unless they opt out) and Medicare payment rates (as reformed by 2013) for the first 3 years that could make the public plan attractive. But the basic idea is to limit eligibility early on to give the institutions a chance to develop, but probably more important, to keep the first 10-year cost impact below the magical $1 trillion level.

Of course, in a rational world, with responsible leaders, we’d realize that "it’s the economy, stupid, not the federal budget" that matters. The way to save money on health care across the economy would be to accelerate the transition from the financially unsustainable system we have to the one we need to get to.

You’d introduce the cost-saving reforms and the transitions as quickly as possible, allowing for usual start-up problems and surprises — things we probably can’t avoid. Over time, an accelerated schedule would probably save us more money than we’d have saved by delaying in the initial 10-year budget that CBO looks at.

But if we want Congress to accelerate this schedule and open the gates, we must also ask them to increase the $1 trillion budget impact ceiling they’ve imposed on themselves. Watching cable news shows focus almost exclusively on how awful it will be to have a very progressive proposal to raise even the $1 trillion for the slower schedule, we should have no illusions about how easy getting even that amount will be.

More:
slinkerwink, We need you to fight for the public option!
White House, redefining bipartisanship
Labor official on Fox, why health reform needs to succeed (video)
NYT, Massachusetts finds is can’t subsidize legal residents
McJoan/dKos, new Progressive Caucus support for public plan
Kaiser Health News, explains in more detail why the exchange/public plans were deliberately limited, and everyone knew it.
Robert Reich, Tax the Wealthy, Make Everyone Healthy