Yesterday, the Director of the Congressional Budget Office, Doug
Elmendorf, delivered a serious blow to Democrats' credibility on
health care when he
testified that none of the Democratic bills he's looked at
would decrease federal health care spending, which is the stated
justification for the urgent need to pass their legislation. In
fact, it would only make the problem worse.
Today, the White House responded with a new proposal to save
money on Medicare: create a commission! Of course, lawmakers
would vote on health care legislation before the commission gets
created or has the chance to issue any recommendations. So they'd
be asked to take a leap of faith -- so that even though
legislation adds to our health care cost crunch, they'll have to
trust that this commission will solve the problem down the road.
But reading the
description of the the proposal by Peter R. Orszag, director
of the White House Office of Management and budget, I was also
struck by the eerie similarities it has with Tom Daschle's idea
of creating a Federal Reserve Board for health care, which he
called a Federal Health Board.
Before he was elected, Obama
praised the idea, and ended up appointing Daschle to lead the
White House health care effort -- only to be sidetracked when
Daschle stepped down due to tax issues. While the Federal Health
Board has never been formally introduced, aspects of the idea
have been reflected in the administration's thinking,
particularly the emphasis on comparative effectiveness research.
But the commission proposed today comes a lot closer. And just to
demonstrate how close, compare how Orszag describes the Medicare
commission to how Daschle described the the Board in his book
Critical: What We Can Do About the Health-Care Crisis.
Orszag wrote:
The Independent Medicare Advisory Council (IMAC) would be an
independent, non-partisan body of doctors and other health
experts, appointed by the President, confirmed by the Senate,
and serving for five-year terms.
Here's Daschle (Critical, page 170):
The Federal Health Board would be a quasi-governmental
organization. It would have a board of governors consisting of
clinicians, health benefit managers, economists, researchers,
and other respected experts...The president would appoint them
to Senate-confirmed, ten-year terms.
Orszag:
There are a number of steps that can be taken to bend the curve
– health IT, investing in research into what works and what
doesn’t, and changing incentives so that doctors and hospitals
give you better care not just more care.
Daschle (Critical, page 171):
In an ideal world, the staff (of the Federal Health Board)
would have access to privacy-protected electronic health record
data to use to identify what works and what doesn't.
Orszag:
As with the military base-closing commissions, this proposed
legislation would require the President to approve or
disapprove each set of the IMAC’s recommendations as a package.
Daschle (Critical, page 116), under the headline,
"Models for Health Care Reform," urges people to:
Consider the Base Realignment and Closure Commission (BRAC),
which deals with an issue that would be difficult, if not
impossible, for lawmakers to tackle.
Orszag:
This approach would free Congress from the burdens of dealing
with highly technical issues such as Medicare reimbursement
rates while rightly giving them, your representatives, a say in
the matter.
Daschle (Critical, page 136):
During the push for reform, the promise of a board would allow
legislators to defer some of the tough technical decisions that
have derailed previous efforts.
There are differences between the two ideas, to be sure. Daschle
envisioned a broader role and greater powers for the Federal
Health Board. For instance, its recommendations would be binding
for all federal programs, while Orszag said the recommendation's
of the commission could be struck down by the president or
Congress. But it's easy to see how the idea of a Medicare
commission could become more powerful over time, just as, for
instance, the Federal Reserve Board has. Orszag doesn't suggest a
sunset provision for the commission, but instead writes that,
creating such a body "would make sure that there is someone
always on the beat, looking for ways to bend that curve."
And in Critical (page 179), Daschle describes how
Federal Health Board recommendations for federal programs could
be more broadly adopted:
In the past, private insurers have followed Medicare's lead in
areas such as refining the hospital payment system, and the
Board's coverage decisions could have the same spillover
effect. Private insurers participating in the new (exchange)
might find it hard it hard to maintain separate sets of rules
for enrollees inside and outside the pool, and employers might
use the Board's recommendations as a guide in crafting their
own health benefits packages. Furthermore, Congress
could opt to go further with the Board's
recommendations. It could, for example, link the tax exclusion
for health insurance to insurance that complies with the
Board's recommendations.
Emphasis mine.
The point is, there is more than one ways to skin a cat, and
Obama is pursuing many avenues to chart a course for the eventual
government takeover of health care.
