Is There No Political Problem That a Powerless Independent Commission Cannot Solve?


Dave Leonhardt's NYT column today looks at ways that health care reform legislation attempts to address the rising cost of health care. One solution, he says, is of particular importance. Leonhardt says that "economists put the idea near the top of their wish list, as has President Obama. It has the potential to bend the curve of Medicare spending, as the experts say, and eventually spread to the rest of medicine."

What is this mysterious and powerful reform idea? According to Leonhardt, it's "the creation of an independent commission with the power to suggest changes to Medicare payment rates." (Bold mine.)

That's right, the key to keeping health care costs down is the power to say to Congress, "Hey, maybe you might consider cutting payments to some of your constituents. Maybe. Possibly. Perhaps. You know, if you want to." To which Congress will obviously respond by telling constituents that sometimes payment rates have to drop for the larger good, and ignoring organized lobbying efforts to keep payments from dropping. 

Yes, yes, I snark—but not without cause! There's good reason to believe that Congress will simply ignore such suggestions. In the past, changes to reimbursement rates have been governed by a formula, but Congress consistently voted to avoid making cuts based on that formula. Why should this be any different? 

As former CBO chief Douglas Holtz-Eakin recently wrote, "Everyone knows that Congress will never surrender its budget authority to independent commissions." And, when I reached him on the phone last week, he told me, "They surrendered their budget authority to a formula, but they took it right back." To Congress, in other words, when it comes to cutting payments to powerful constituencies, there's little difference between a formula and a commission.

NEXT: Obama's Appetite for "Unprecedented" Crisis and Response

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  1. What is this mysterious and powerful reform idea? According to Leonhardt, it's "the creation of an independent commission with the power to suggest changes to Medicare payment rates."

    "You, Congress, are under our spell; you will do our bidding; you...."

    "Psst, it's the power to suggest, not the power of suggestion!"

    "Oh... darn it."

    1. I suggest they drop the facade of all their various programs 'to help the people' and call them what they are. It would save on advertising budgets. Don't call it Cash For Clunkers, just call it Cash For Votes.

      Health Care Reform? Yeah right, just call it Federal Human Management.

      War on Drugs? War on Poverty? War on Terror? Just tell it like it is and call it the Generalized War On Behavior.

  2. http://www.washingtonpost.com/.....02079.html

    Our New Medical Judges?
    By David S. Broder

    ...Obama is recommending that the successor agency, IMAC, be smaller and potentially more decisive. Under his plan, the president would name five physicians or other health-care-savvy members to serve for five-year terms on its board, picking one of them as chairman. Like the nominees to the Fed and the Supreme Court, they would have to be confirmed by the Senate.

    Each year, IMAC would have two responsibilities. First, it would recommend to the president updated fees that Medicare would pay doctors, hospitals, rehab centers, nursing homes, labs, home-care and ambulance services, equipment manufacturers, and all other providers. That is now done by Congress itself, and the lobbying by potent hometown individuals and institutions is one reason Medicare costs keep growing. To control costs, IMAC's recommendations could not exceed the "aggregate level of net expenditures" under Medicare.

    Second, IMAC would annually recommend a set of broader reforms to improve the quality or reduce the cost of medical care. On each report, the president would have 30 days to approve or reject the recommendations, but he would have to act on the whole package, not pick it apart.

    If he approved, the package would go to Congress and could be overruled only by joint action of the Senate and House within 30 days. Absent that, the secretary of health and human services would order the changes into effect. ...

  3. The good government is just trying to keep us safe...

    Safe from pain, and truth, and choice

    Every poison devils

    See they don't give a fuck about you...like I do.

    They'll be Counting Bodies Like Sheep to the Rhythm of the War Drums.

    1. Your comment is perfectly circular.

  4. There's good reason to believe that Congress will simply ignore such suggestions.

    Mammograms, anyone?

    1. Hmm, yes that sounds good, I'll have mine on the rocks with salt.

      1. How about an abortion to go with it?

  5. Who appoints the independent commissioner?

    1. Why, we appoint ourselves.

      * looks offstage, winks *

  6. "economists put the idea near the top of their wish list"

    This is really fucking stupid. No legitimate economist would come up with something this retarded and ineffective.

  7. If we can't make science based decisions with regard to mammograms - or more accurately, if we will not charge more, or deny more, any test that has ANY possibility of being useful - well, health insurance costs to the moon!!!

  8. You know, you folks should just give in and call them Royal Commissions.

    And get one on health care done by a premier whose premier accomplishment was closing rural hospitals.

    What is this with half measures?


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