Even Democrats Don't Support Obama's Plan to Bring Down Medicare Spending


Here's why President Obama's plan to cut $480 billion in Medicare spending over the next dozen years won't work: Even members of his own party don't support it. From The Hill:

Rep. Allyson Schwartz (D-Pa.) on Friday urged lawmakers to repeal a controversial provision of the healthcare reform law that President Obama says is central to his deficit-cutting efforts.

Obama in his deficit speech Wednesday urged lawmakers to strengthen the law's Independent Payment Advisory Board (IPAB), which sets Medicare cost targets and recommends payment cuts if they're exceeded. In a "Dear Colleague" letter just two days later, Schwartz instead advocates for getting rid of the board altogether.

"While I embrace the goal of reducing costs," she wrote, "I cannot condone the implementation of a flawed policy that will risk beneficiary access to care.

This is what I was talking about yesterday when I wrote that a big part of the problem with counting on IPAB to produce savings is that it's politically unstable. Health industry groups are determined to kill it. And legislators in both parties are highly sympathetic to the industry message (as Suzy Khimm notes at Mother Jones, the panel "was never popular among House Dems") in large part because IPAB substantially reduces Congressional authority over Medicare. Industry groups don't like seeing their payments reduced (likely a big part of how IPAB would achieve its savings), and members of Congress don't like handing off their authority to an executive branch commission.

We've already seen Congress repeatedly undermine the savings that were supposed to be generated by the Sustainable Growth Rate—the formula designed to keep doctors' Medicare reimbursements under control. Every year, the formula calls for cuts, and every year Congress, under pressure from doctors' groups and seniors' organizations, votes to override those cuts. With IPAB, it seems distinctly possible that Congress will vote to either get rid of the board or severely limit its power before it really even gets started. 

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  1. and members of Congress don’t like handing off their authority to an executive branch commission.

    Since when? Seems like all they do is hand off their authority to various unelected bureaucracies.

    1. Maybe he was referring to another congress. The US Congress is more concerned about getting tarred with the “death panel” issue.

      1. gov brewer sure wasnt concerned about that in arizona

      2. That puzzled me, too. It seems like Congress likes nothing better than handing off responsibility to agencies.

        I’m thinking they’re just allergic to anything that can be called a death panel.

        1. They like handing off responsibility when it’s a way to avoid tough decisions. When it comes to being able to dole out favors, not so much.

          1. Yes. Perfectly stated.

            Any board that makes old people in their districts squeal becomes a thorn in the Congressperson’s side. Of course they want it gone.

            1. Don’t knock old people. Old people keep Florida from having an income tax.

              1. We don’t have an income tax in Washington, yet it’s not because of old people. Maybe you need to rethink your causation.

                1. ?Alaska
                  ?South Dakota
                  All tax-free states

                  1. No state income tax != tax free

                    1. Don’t try to explain subtlety to rectal, dude. She can’t reason her way out of paper bag.

                    2. epi, no doubt that was a reference to you auto-erotic fetish. Next time leave the bag on longer-an hour longer

                    3. Yeah, Florida isn’t tax free by any stretch of the imagination. But we benefit from having lots of tourists, whom we gouge.

                    4. no state income tax = way higher state sales tax

                    5. Texas Sales tax in major cities – around 8%. Income Tax – 0%. Colorado Sales tax in major cities (OK – Denver) around 8%. Income Tax – 4.63%

                    6. Way higher than what?

                    7. “no state income tax = way higher state sales tax.” Really? New Hampshire has neither. And one of the most consistently robust economies in the country.

                    8. Hear hear! And what are the sales tax rates in those states compared to other states?

                2. It’s not the cause, it’s the protection. And you’ll likely be seeing an income tax one of these days without more old people to protect you. Look around. . .do those people look like the type that wouldn’t vote for an income tax?

                  1. Texans would hang any politican who brought up the idea

  2. Getting Congress out of the decision making process on payment cuts is a feature – not a bug.

    1. Best way to get Congress out of decision-making process for health-care costs is to get the government out of the health-care business.

      Nuke it from orbit, its the only way to be sure.

      1. fine get the government out of health care but the insurance companies can’t stay in it either-they are as trustworthy as a campaigning politician

        1. One-word solution: Competition.

          1. three-word problem: McCarran-Ferguson Act

            1. That’s why there isn’t enough competition. So what could we do about that?

              1. The first thing we do, let’s kill all the lawyers

                1. That might help, for a time. In any event, the deregulation of health insurance, along with a phase-out of government as a direct player in the market would do wonders. I’d like to take the government totally out of healthcare, but just the above would be a great improvement.

                  1. The problem is that health insurance it is truly misnamed for the elderly and the chronically sick. Their insurance claims outweigh their payments and without government the HC industry will shed these ‘dead-weights’.

                    1. without government the HC industry will shed these ‘dead-weights’.

                      How is that a problem?

                    2. No. You don’t understand how insurance works.

                    3. Who are you replyng to?

        2. I can sue my insurer for breaking our contract; I can’t sue my congressman for not voting like he promised.

        3. Congress has allowed states to “regulate” (and I use quotes as control is more accurate) the insurance industry. The result is higher prices, more you have to pay for (e.g., your insurance will cover fertility treatments even if you’re over 60). Congress should allow us to purchase insurance across state lines. That competition would significantly lower prices and improve quality (of the insurance products).

    2. Why do you hate democracy, shrike?

  3. For somebody who’s supposed to be such an excellent communicator, Obama sure knows how to create a bunch of cognitive dissonance out of nothing…

    Or! There is another explanation!

    Maybe he just doesn’t know what he’s doing.

    1. Or most likely the far left Dems who wanted single-payer are still angry with Obama for sticking them with the Heritage/Romney health care reform ideas from 1993-2004.

  4. IPAB was doomed from the start. you saw the flack over the US Prevention Task Force recommendation to cut back on mammograms, even though the science backed its position. no way any real cuts or reforms from IPAB survive.

  5. and members of Congress don’t like handing off their authority to an executive branch commission losing their bribes.

  6. Lies are one of the few things that Americans still manufacture.

    1. This should come as no surprise to anyone. I purposefully am nice and civil and light-hearted with the TSA scum, even though in my head I’m “very arrogant and expressing contempt”, because like any petty tyrant, if you don’t respect their authoritah, they’ll make you pay.

  7. According to David Goldhill (author of “How American Health Care Killed My Father”, CEO and lifelong Democrat) discovered that seniors on Medicare now pay more out of pocket than before Medicare existed. Try to wrap that fact around your head. Why does medical care cost seniors more now than before, when government is going broke paying for it? It’s a result of how messed up the marketplace for medical care has gotten thanks to government.

    This means that Medicare is a bad deal for all of us. We need some politicians who’ll change Medicare to give seniors vouchers to pay for insurance/medical care rather than paying directly to providers. This would be much easier than paying doctors less, and would eliminate the 3rd payer problem here.

  8. The biggest farce is that the advisory panel is prohibited from cutting payments to hospitals, clinical laboratories, and pharmaceutical companies. Those three areas represent the biggest costs to Medicare. Provider payments (I.e. doctors, physical therapists, home health care nurses) are the only payments they can cut. Those represent only 4% of Medicare spending. They aren’t serious about reform.

  9. So what plan to significantly reduce Medicare expenditures is going to be “politically stable”? Ryan’s “plan” simply kicks the can down the road for a decade. What will happen when today’s 55-year-olds discover they’ll be paying out of their own pocket for less care than geezers like me get for free? How are they going to like it when they discover they have to pay more every year? And how are geezers like me going to like it when those young whippe-snappers try to take away our Medicare? Sounds like a party to me.

  10. Original, documented investigation on Kaiser Permanente’s rigged end of life counseling, “Birth of a Real Life Death Panel,” is posted on at Panel Birth & Attachments 1st in Series 2-14-2011.pdf
    Twenty years ago, Dr. Ezekiel Emanuel, ObamaCare’s ethics engineer, published that he had invented a scheme that induced 70% of patients to reject treatment and life support in a 15 minute end of life counseling session.
    Robert Finney, Ph.D.

  11. Some kind of Medicare reform plan must be put into place. It is an extremely controversial topic and will take years to come to a conclusion.

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