A comment made in passing by President Obama has created a major sticking point in negotiations between Congressional Democrats in the House Energy and Commerce Committee.
(And no, it's not about James Crowley or Henry Louis Gates.)
Obama said he supported an idea that was originally created by Republicans: MedPAC.
Q: What do you think about taking it out of the political realm and giving it to an outside body of experts to take the politics out of Medicare?
THE PRESIDENT: Well, on the second point, that's exactly what our proposal is, called the MedPAC program....
UPDATE: See the impact of HR3200 in your area here.
This caught my attention.
MedPAC, Obama said, was originally an idea passed by the Republican Congress.
The Republican Congress passed a bill that created a panel of health care experts to make recommendations to Congress on how we could get better quality, lower cost. The problem is every year it would just go on a shelf, and nobody would act on it.
According to MedPAC's website, the commission is set up to address improvements to the delivery of Medicare - a continuous quality improvement agency that helps to effect changes that improve quality, reduce cost, and eliminate waste and fraud.
The Medicare Payment Advisory Commission (MedPAC) is an independent Congressional agency established by the Balanced Budget Act of 1997 (P.L. 105-33) to advise the U.S. Congress on issues affecting the Medicare program. The Commission's statutory mandate is quite broad: In addition to advising the Congress on payments to private health plans participating in Medicare and providers in Medicare's traditional fee-for-service program, MedPAC is also tasked with analyzing access to care, quality of care, and other issues affecting Medicare.
The Commission's 17 members bring diverse expertise in the financing and delivery of health care services. Commissioners are appointed to three-year terms (subject to renewal) by the Comptroller General and serve part time.
Who's currently on the commission?
Chairman:
Glenn M. Hackbarth, J.D.
Bend, OR
Vice Chairman:
Francis J. Crosson, M.D.
The Permanente Federation, LLC
Oakland, CA
Mitra Behroozi, J.D.
1199SEIU Benefit and Pension Funds
New York, NY
Robert Berenson, M.D., F.A.C.P.
Urban Institute
Washington, DC
John M. Bertko, F.S.A., M.A.A.A.
Flagstaff, AZ
Karen R. Borman, M.D.
University of Central Florida College of Medicine
Orlando, FL
Peter W. Butler, M.H.S.A.
Rush University
Chicago, IL
Ronald D. Castellanos, M.D.
Southwest Florida Urologic Associates
Ft. Myers, FL
Michael Chernew, Ph.D.
Harvard Medical School
Boston, MA
Thomas M. Dean, M.D.
Horizon Health Care, Inc.
Wessington Springs, SD
Jennie Chin Hansen, R.N., M.S.N., F.A.A.N.
AARP
San Francisco, CA
Nancy M. Kane, D.B.A.
Harvard School of Public Health
Boston, MA
Herb Kuhn
Health care consultant
Washington, DC
George N. Miller, Jr., M.H.S.A.
Community Mercy Health Partners, Catholic Health Partners
Springfield, OH
Arnold Milstein, M.D., M.P.H.
Pacific Business Group on Health
San Francisco, CA
William J. Scanlon, Ph.D.
Health policy consultant
Oak Hill, VA
Bruce Stuart, Ph.D.
The Peter Lamy Center on Drug Therapy and Aging at the University of Maryland Baltimore
Baltimore, MD
These include healthcare executives, physicians, public health experts - it's a top-flight board equipped to manage direct a nonprofit healthcare system. The recommendations made by the commission have not been taken seriously, and this, in part, has put us in the situation we're in now. It takes "an act of Congress" (literally) to fix things with Medicare, and every decision is politicized and subjected to the lobbying and scrutiny of special interest groups. It's a highly ineffective system, not only because it is bureaucratic but because lobbyists and special interest groups play the system.
Now, I'm not sure what the opposition is about, but I have some ideas. First, it's hard for Congress to give up legislative power. They don't want to follow other people's recommendations, and they don't want to be forced to make tough decisions that could be misinterpreted or misconstrued. Second, the idea that you'd take ALL of MedPAC's decisions and simply make an "up or down vote" on it (as Obama suggested) is a risky and messy idea, politically. Why can't you "take what you want and leave the rest"? Third, the MedPAC commission itself can become politicized. In many ways, it would become like the Supreme Court of healthcare decisions. That's a lot of power, even if the appointments are for three years rather than for a lifetime.
I compare MedPAC to the Supreme Court because we all know what a freak show the Sotomayor hearings were. Republicans on the Judiciary Committee took the audacity of stupid to a whole new level. And since there are clearly differing views of justice, confirmation hearings can really demonstrate the biases and prejudices of members of Congress. MedPAC's power would actually be similar in many ways to the power of the Joint Chiefs of Staff or perhaps the Federal Reserve bankers. It would be powerful to effect policy changes, but MedPAC's members will only serve 3-year terms.
In my opinion, MedPAC power is a good thing, because it strengthens the federal power of the executive instead of putting policy-making power in the hands of a few elected officials from specific districts (in places like, say, Beverly Hills). And so, since MedPAC would be looking at the whole system, they'd be less susceptible to ignoring or exploiting regional differences.
The problem with the MedPAC model comes if you have a group in Congress (or the White House) which is fundamentally opposed to the success of Medicare. MedPAC members who are too cozy with drugmakers, insurance companies, or hospital groups could easily tilt the scales of healthcare justice in favor of their corporate friends. But since you've got a 3-year rolling board, new members should offset the old ones and the balance shouldn't ever get too far off. (And if it does, we just vote the bums out!)
The report from HuffPo's Ryan Grim today is that negotiations broke down between Blue Dogs and Waxman specifically because of the MedPAC provisions. Blue Dogs actually want what Obama wants. Waxman blocked it.
The mood among Democrats has turned acrimonious.
"I've been lied to," said Rep. Charlie Melancon (D-La.). "I have not had legitimate negotiations. They've accused us of sabotaging health care. We are not."
Melancon spoke to reporters before heading to the Rayburn House Office Building for a meeting of all the Democrats on the Energy and Commerce Committee. It's likely to be a lively affair.
Melancon said that Waxman told a Blue Dog member in the back of the chamber Thursday night that the so-called MedPac deal would be difficult to complete because liberals were pushing back against the idea. "He told Mr. Ross that the liberals wouldn't do it," he said.
Stay tuned.