The Washington Post
x
S
Obama Wants Lawmakers to Stop Setting Medicare Payments
MEDICARE, From Page A1
are determined to stem soaring Medicare spending, arguing that it is a root cause of the broader health-care crisis that they are try- ing to address with Congress. Be- hind the scenes, Obama is pushing for a mechanism that would take Medicare payment authority out of the hands of politicians and in- vest it in a separate entity, pos- sibly under the executive branch. “Structures that fundamentally alter the long-term costs are a must for real health-care reform,” said White House Chief of Staff Rahm Emanuel. He called the Medicare payment debate “the least talked-about, most important issue on the table.”
House Democrats’ health-care proposal, released Tuesday,
in-
cludes no measures aimed at re- versing the long-term cost trajec- tory of Medicare, a fact that spurred a rebellion among conser- vative Blue Dog Democrats on the Energy and Commerce Commit- tee, which will begin debate on the House bill today. Rep. Mike Ross (Ark.), a Blue Dog leader and pan- el member, told reporters yester- day that he has the votes to defeat the package unless it is “sub- stantially amended” to address long-term cost concerns.
The Senate health committee
approved its own bill yesterday on a party-line vote; that package also was silent on the issue of Medi- care’s growth. “We need to make it happen,” Senate Finance Committee Chair- man Max Baucus (D-Mont.), whose panel has jurisdiction over Medicare, said of payment reform. Baucus is crafting a separate pro- posal to pay for expanded health- care coverage, but that task is complicated by the fact that he is also attempting to win the back- ing of lawmakers such as Sen. Olympia Snowe (R-Maine), a cru- cial swing voter who opposes White House efforts to shift con- trol of the Medicare payment equation. Snowe said Finance Committee members have debated payment reform at length in recent closed- door meetings, but did not reach a consensus. She said her chief wor- ry is that providers would contin- ue to look to lawmakers to protect their interests but that under a new system, she and others would be unable to respond to their con- cerns. Congress must retain the ability to “shape and influence” Medicare rates, Snowe said. “We’re still going to be held ac- countable.”
Obama urged House and Senate leaders to action during a White House meeting this week, and at the request of committee chair- men, administration officials yes- terday sent two proposals to Capi- tol Hill aimed at addressing the problem. One would empower the Medicare Payment Advisory Com- mission (MedPAC), a nonpartisan body of health-care experts that serves Congress in an advisory role, to determine cuts and chang- es to Medicare, akin to the Federal Reserve Board. “It’s not perfect, but it does a lot better job than what Congress is doing,” Rep. Jim Cooper (Tenn.) said of the com- mission. Cooper, a Blue Dog, co- sponsored the proposal with Sen. John D. Rockefeller IV (D-W.Va.), a senior Finance Committee mem- ber.
The second proposal would cre- ate a similar entity, called the In- dependent Medicare Advisory Council, to make Medicare recom- mendations to the president. Law- makers could vote to overturn de- cisions with which they disagreed but could no longer tailor Medi- care spending to address local concerns.
Medicare and Medicaid spend-
ing now accounts for 5 percent of gross domestic product, and if both programs grow at the same rate over the next 40 years as they have for the past four decades, they will eventually hit 20 percent of GDP, according to estimates. Congress is attempting to ex- tract as much as $500 billion in Medicare cost savings to pay for health-care reform, but Obama ad- ministration officials are con- cerned that those savings would not result in the transformative fixes the system needs to be stabi- lized for the long term. White House officials say their own pro- posals for payment reform would make the system more flexible, al- lowing it to respond to devel- opments such as breakthroughs in treatment. “We’re trying to create a struc- ture where that would be easier to reorient the system towards high- er value and lower cost in the fu- ture,” said White House budget director Peter Orszag.
The long-term cost challenge has emerged as a major point of contention as new health-care leg- islation creeps closer to becoming a reality. White House officials and Democratic fiscal hawks wor- ry that Congress could provide coverage to millions of uninsured people, expand the government’s
50% OFF
DESIGNER
SANDALS
• ENZO ANGIOLINI • MARC FISHER
• CIRCA JOAN & DAVID • AK ANNE KLEIN • JESSICA SIMPSON • STEVE MADDEN • FRANCO SARTO • NINE WEST
• BCBGIRLS
Reg. $39-$99, sale 19.50-49.50.
role in health care, and yet fail to “bend the cost curve,” creating a fiscal disaster for the nation and a political disaster for their party. Republicans are warning that Democrats are charting a ruinous path, and those criticisms are be- ginning to resonate.
Senate Finance Committee member Ron Wyden (D-Ore.) said such concerns have elevated the Rockefeller-Cooper proposal from a nonstarter to an idea that is gain- ing traction. “That’s getting a very
serious look right now,” Wyden said.
MedPAC was created in 1997 to address Medicare’s grim prospects as health-care costs outpaced in- flation and retiring baby boomers caused the program’s ranks to swell. As the country’s largest health-insurance program, cover- ing nearly 40 million of the most expensive patients, the entitle- ment program also holds extraor- dinary influence over the health- care marketplace.
A flood of carefully researched
MedPAC reports set forth specific ideas for addressing Medicare’s many deficiencies. In testimony before the House in late June, MedPAC Chairman Glenn M. Hackbarth summed up his view of the problems. “The health-care de- livery system we see today is not a true system: Care coordination is rare, specialist care is favored over primary care, quality of care is of- ten poor, and costs are high and in- creasing at an unsustainable rate,”
Hackbarth told Energy and Com- merce Committee members. But for most lawmakers, resist- ing the armies of health-care lobby- ists who are deployed to protect in- dustry interests has proved diffi- cult. “Basically, the cards are stacked against the member who has to confront these groups,” said George F. Grob, who conducted numerous Medicare reviews through the Department of Health and Human Services’ inspector general’s office. “Look at who
Thursday, July 16, 2009 A5
they’re confronting — the cancer doctors. Drug companies saying, ‘We’re the ones saving lives out there.’ Hospitals saying, ‘We’re go- ing to have to shut down.’ ” Such concerns are often con-
veyed to politicians by former col- leagues or aides who have joined industry ranks. “They’re talking to their friends,” Grob said. But also, he said, the lobbyists “make really good arguments. They really know their stuff, and they understand the process. They know what the life cycle of a bill is, they know who to talk to, they know what they’re talking about — and they reach everybody.”
HOTSUMMERSALE
STOREWIDE SAVINGS, CLEARANCES & VALUES
SAVE ON SANDALS AND SHOES IN THE STYLES YOU’LL WEAR YEAR AFTER YEAR
REG. PRICES ARE OFFERING PRICES, AND SAVINGS MAY NOT BE BASED ON ACTUAL SALES. Due to consolidation, some prices may be different at your local Macy’s. You will receive prices at or lower than prices advertised here. Advertised items may
not be available at your local Macy’s, and selections may vary. SALE PRICES IN EFFECT THROUGH 7/22/09. For store locations & hours, log on to macys.com
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66