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.
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.
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.
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.
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.
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.
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