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Department Of Crankiness

Ezra Klein has a less sanguine take about today's meeting and wonders if he's just being cranky.

As one senior administration official said to me, "this is a commitment, not a plan." The industry coalition has gestured towards various areas of potential savings--among them billing reform, health information technology, and linking payment to outcomes. But they've not presented a detailed proposal for attaining them. They have not set down enforcement mechanisms. Put simply, they are, at this juncture, helping the White House with its messaging. But that doesn't mean they will help the White House with its plan.

Which gets to my skepticism: This is one of those moments when new words are being used to drown out ongoing actions. A major source of potential savings, at least in the administration's estimation, will come from comparative effectiveness review. But the pharmaceutical industry and the device industry--both of which are represented here--fought violently against CER when the Obama administration sought to include it in the stimulus. By the end, they had managed to win legislative language stating that comparative effectiveness studies wouldn't include cost-effectiveness and wouldn't be used to make coverage decisions.  

I don't think Ezra is being cranky. (That's Henry Aaron's department, although we all love and revere him for it.)  As I wrote in my item today, I think skepticism about the commitment of these groups is altogether legitimate. The posturing we'll see at the White House belies the opposition some of these same groups have mounted, and will mount, against key elements of reform.

But even half-hearted posturing can have a major political impact or, at least, reflect major political change. I still think that's the case today.

Update: Igor Volsky and Matthew Yglesias on what this all has to do with the Congressional Budget Office. (A lot!) More on that subject later. 

--Jonathan Cohn