OMB Sends Letter to the Hill Recommending MedPAC Reform
As alluded earlier the White House is preparing to really throw its shoulder behind the idea of reforming the Medicare Payment Advisory Commission as a way to get some more curve-bending into health care legislation. The latest sign of that is a letter from OMB Director Peter Orszag addressed to key legislative leaders in the House and Senate. The letter touts Senator John Rockefeller’s MedPAC legislation but really gets behind a slightly different idea.
Per the OMBlog:
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. The IMAC would issue recommendations as long as their implementation would not result in any increase in the aggregate level of net expenditures under the Medicare program; and either would improve the quality of medical care received by the program’s beneficiaries or improve Medicare’s efficiency.
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. If the President accepts the IMAC’s recommendations, Congress would then have 30 days to intervene with a joint resolution before the Secretary of Health and Human Services is authorized to implement them. If either the President disapproves the recommendations of the IMAC or Congress passes such a joint resolution, the recommendations would be null and void, and current law would remain in effect.
Orszag also shows why he’s not just a wonk, he’s also a diplomat. The way I earlier described the virtues of this idea was “that ‘Congress’ and ’sound management of public policy issues’ aren’t really concepts that go together.” Orszag puts it differently, “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.”
Free them from the burden!
2 Responses to “OMB Sends Letter to the Hill Recommending MedPAC Reform”
Register
RSSLogin
Topic Cloud
ArchivesBlog RollAbout Matt YglesiasContact Me
Donate
July 17th, 2009 at 2:56 pm
Interesting. The slight differences are actually kind of big, in a strange sort of institutional way. It’s about which branch ultimately gets the control.
Under the Orszag recommendation, the power rests pretty much with the executive farmed out to this body. It is an independent, but still executive branch agency, subject to OMB clearnance and the like. Furthermore is the notion of what happens if Congress dislikes it. It can make changes, but through Joint Resolution. Likely, if it is sort of linked to the President, it is unlikely that he would sign something that disapproves of any portion of something he signed into force. It essentially brings back the old INS v. Chadha problem.
The another version is a little more like what we saw in BRAC. It forces Congress’s hand to go on record and vote on the matter through various precommittal means. It can go completely up or completely down. It could “amend” but only under certain rules (like budget neutrality).
Which way is preferrable is a difficult issue. These are actually matters that are subtle and mindbending, but Administrative Law Scholars debate it quite frequently. Indeed, it is an issue I have personally thought of for a while.
Some precommittal is necessary, it’s just the form. But, form on these things have a certain importance.
July 22nd, 2009 at 12:56 pm
[...] Medicare payment recommendations, as a good way to produce efficiencies in health care reform. I am also enthusiastic about this idea but it is important to note one wrinkle here. One thing that’s [...]