There are, I'm told, two policies under consideration. The first is a version of Senator Jay Rockefeller's MedPAC Reform Act. This legislation would move MedPAC into the executive branch. The commissioners would be approved by Congress and appointed for six-year terms. Beyond that, it would largely be an autonomous agency, able to set Medicare payment rates, conduct trial programs, and fund policy initiatives.
The theory is that it would act as a Federal Reserve for Medicare. "Congress has proven itself to be inefficient and inconsistent in making decisions about provider reimbursement under Medicare," said Rockefeller. "Congress should leave the reimbursement rules to the independent health care experts.”
That's the plan Obama spoke of favorably in yesterday's meeting. But what hasn't been reported is that senior administration officials are also considering another variant: This plan would package MedPAC's yearly recommendation and fast track them through Congress for a simple, up-or-down vote. No filibuster. No changes to the package of recommendations. Health reform, under this scenario, would become a yearly legislative project.
And that's how some in the White House would prefer it. The health system changes too quickly for Congress to address through massive, infrequent, efforts at total reform. New technologies and new care structures create new problems. A health care reform package signed in 2009 might miss some real deficiencies, or real opportunities, that present themselves in 2012. A health reform process that recognizes that fact is a health reform process that is continual, rather than episodic.
And the second:
Medicare is effectively frozen. For a long version of this argument, read Bob Berenson and Len Nichols' argument in Making Medicare Sustainable. Last night, I spoke with Nichols, however, and he put it more pithily: "The thing I'd say about the whole genre of proposals in this area is that it's really about empowering information and science and evidence over lobbying. Everything else is a device to make that happen."
"The members of the Finance Committee now who have been there a long time get this," continues Nichols. "They know the Center for Medicare and Medicaid Services does their due diligence and takes their public reporting responsibilities seriously and that device manufacturers present their case to CMS and frequently lose. And when they lose, they come to Congress and get friendly senators to sponsor an amendment and overturn CMS's rules. Every member of finance has seen this hundred times."
This proposal is about stopping time 101 from happening.
Good points, Ezra Klein!
2. Ben Smith concisely unpacks the problem with the Republican Party's use of code language in judicial fights:
Ken Vogel writes up some White House talking points on Sotomayor that identify her as, among other things, "exactly what conservatives want: a nonactivist judge who does not apply her own views but is bound by the law.”
You'd think that sort of characterization might bother Democrats, but in fact the White House is taking advantage of how abstract the right has made the judicial debates, focusing not on abortion but on principles like judicial activism, which is abstract enough to be repurposed to the Democrats' advantage. And the left appears mostly to have been given the assurances it needs that she'll be a reliable vote to uphold Roe.
Good point, Ben Smith!