Obama’s Letter
There seem to me to be two noteworthy things in the letter to Ted Kennedy and Max Baucus from Barack Obama that the White House just dunked into my inbox. One is that the President continues to push for a public option, writing “I strongly believe that Americans should have the choice of a public health insurance option operating alongside private plans.” A little while back, I think it was generally thought that the public option was largely a kind of kabuki bargaining tactic, but people are now putting serious political muscle behind it. A slightly duller, but in some respects more important, aspect of the letter is this idea:
To identify and achieve additional savings, I am also open to your ideas about giving special consideration to the recommendations of the Medicare Payment Advisory Commission (MedPAC), a commission created by a Republican Congress Under this approach, MedPAC’s recommendations on cost reductions would be adopted unless opposed by a joint resolution of the Congress. This is similar to a process that has been used effectively by a commission charged with closing military bases, and could be a valuable tool to help achieve health care reform in a fiscally responsible way.
Ezra Klein explains some of the import of this. But to make a long story short, this MedPAC idea is part of closing the gap between the cost savings we “could” achieve through reform and actually achieving cost savings. MedPAC is basically an expert committee that comes up with smart recommendations on Medicare payments that it offers to congress. But then Congress doesn’t actually do anything. What they’re looking to do here is to change the decision-process so as to make it much more likely that MedPAC’s ideas would be implemented, by shifting to a BRAC model whereby congress could block the recommendations as a whole but couldn’t modify them or kill the whole process with delay.
As the main characteristic of the American political system is status quo bias, these kind of changes to the default rules can have a big impact. This seems like a very smart ideas.
10 Responses to “Obama’s Letter”
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June 3rd, 2009 at 3:34 pm
First of all, this bizarre political tactic of Obama’s where he gives his proposals and demands up front, and then actually stands by them is truly sneaky and underhanded. Secondly, why can’t we do all legislation this way?
June 3rd, 2009 at 3:52 pm
“This seems like a very smart ideas. ”
And probably unconstitutionals, but eh, who cares about that?
June 3rd, 2009 at 4:19 pm
It is a little disorienting to watch a policy initiative start out in a moderately so-so place, and slowly get better the more it gets discussed and fleshed out. So used to seeing the opposite. Health care seems to be getting watered up instead of down.
June 3rd, 2009 at 4:28 pm
I actually think most ideas at MedPac do get implemented. Typically, there is just a time lag between proposal and implementation by about 2-3 years. For instance, the proposal related to the increased expected utilization rates for MRI centers when calculating reimbursement rates was proposed in what 1995 and is now rolling out.
We need to elect people who actually have the balls to do their job. That’s the solution.
June 3rd, 2009 at 4:37 pm
I think Chad is right. Contracting Congress’ job to MedPAC doesn’t get at the root of the problem. The Centers for Medicare/Medicaid already promulgates rules and regulations.
Instead of the people’s representatives exercising their power of the pen, Congress wants to delegate the politically tough work to an independent private group. Calling it a “democratically accountable group” does not make it so.
It shows politics and leadership are not the same thing.
http://stateofthedivision.blogspot.com/2009/06/congress-to-abdicate-leadership-for.html
June 3rd, 2009 at 5:21 pm
“Political language… is designed to make lies sound truthful and murder respectable, and to give an appearance of solidity to pure wind.”
It comes from the piece linked below, but seemed to apply here.
http://www.tomdispatch.com/post/175078/redefining_the_world
June 3rd, 2009 at 5:50 pm
Re: And probably unconstitutionals, but eh, who cares about that?
The Constitution gives both houses of Congress prety broad warrant to establish their own rules, so I don’t see a problem here. And we’ve had other legislation approved on a fast-track up-or-down vote basis.
June 4th, 2009 at 1:17 am
Of course, attach the new healthcare plan to Medicare. It solves both sides of the money question .. taxing and spending.
Now ask yourself ..
Who pays taxes for Medicare ?? Everybody who works.
June 4th, 2009 at 10:44 am
[...] excellent point from Igor Volsky who observes that the idea of cutting health care costs through a beefed-up MedPAC is highly complementary with the idea for a robust public option for non-seniors: This makes the [...]
June 5th, 2009 at 11:31 am
[...] Mattthew Yglesias [...]