Republicans claim to be deeply worried about the deficit — their favorite political target, followed closely by President Obama’s relentlessly demonized health care reform. So why are they so determined to overturn one of the central cost-control mechanisms of the new reform law?
Republicans in both the Senate and the House have introduced bills that would eliminate the new Independent Payment Advisory Board, which is supposed to come up with ways to rein in excessive Medicare spending — and stiffen Congress’s spine.
Starting in 2014, whenever Medicare’s projected spending exceeds a target growth rate, the board of 15 members (drawn from a range of backgrounds, appointed by the president and confirmed by the Senate) will have to recommend reductions in payments to doctors and health care providers to bring spending back to target levels. These recommendations would become law unless Congress — not known for its political courage in such circumstances — passed an alternative proposal that would achieve comparable savings.
None of this poses any real threat to Medicare beneficiaries. The law prohibits the board from making proposals that would ration care, increase taxes, change Medicare benefits or eligibility, increase premiums or cost-sharing, or reduce low-income subsidies for drug coverage. It cannot call for a reduction in payments to hospitals before 2020.
If anything, we fear that the board’s power will be too limited. But its power to curb payments to other providers is projected to save $15.5 billion to $24 billion between 2015 and 2019.
That has not stopped Senator John Cornyn of Texas from trying to kill off the board. In July, he introduced the ever so cutely named “Health Care Bureaucrats Elimination Act.” It currently has 11 co-sponsors, and a similar version, introduced earlier in the House by the Republican Phil Roe of Tennessee, has 54 co-sponsors.
Neither bill will go anywhere so long as the Democrats run Congress, but expect to hear a lot of hype about bureaucrats hijacking health care — and nothing about the needed savings — in this fall’s campaign.
Republicans are also eagerly attacking another important source of savings: the new law’s elimination of the subsidies given to the private managed-care plans known as Medicare Advantage. That is projected to save $132 billion over the next decade, but don’t expect to hear about that part on the campaign trail.
Instead, Republicans are warning seniors enrolled in these plans that their coverage may disappear. Senator John Barrasso, Republican of Wyoming, even charged that the cuts would “kill” the Medicare Advantage program, which now serves some 11 million beneficiaries. That is preposterous.
The law simply forces managed-care plans to compete on an even basis with the traditional Medicare program. Some beneficiaries may face higher costs or lose some gold-plated benefits, but only the most inefficient plans will disappear when the unjustified subsidies that are propping them up are withdrawn.
Republicans are also eagerly, and shamefully, pillorying Dr. Donald Berwick, the new head of the Centers for Medicare and Medicaid Services. There are few figures who command greater respect for uniting health professionals and institutions to improve the quality of medical care while reducing costs. That is not stopping these critics from implying — baselessly — that he will introduce socialized medicine and death panels in this country.
The truth is that Dr. Berwick has praised the socialized British health care system, especially for its emphasis on primary care. This country certainly needs to do more to develop its primary care system. And he has, rightly, called for an open discussion of the health care rationing that is already widespread in our system. When insurers decline to cover procedures, or high prices screen out low-income people, that is rationing.
Dr. Berwick has endorsed the use of “comparative effectiveness” research to determine which treatments work best. He would use such research to judge whether a new drug or procedure is worth the cost of coverage, a step the reform law shies away from. He does not have the power to change that law. But the issue will have to be addressed at some point if there is to be any hope of restraining medical spending.
Democrats have to counter the Republicans’ demagoguery with facts. Americans need to understand that if Senator Cornyn and others get their way, runaway health care costs will only get worse.
Democrats should not be shy about touting reform’s benefits — for improving Americans’ lives or its potential for reducing the deficit. They also need to tell Americans that there are even tougher choices to make ahead. Voters may find it refreshing to hear politicians tell them the truth.