I wasn’t around to watch Obama’s speech yesterday. I did go to CNN later and try to listen to it. I haven’t watched cable TV in months and I don’t know if I was tired and thus vulnerable to confusion or sensory overload, but I had to turn it off. It was 30-second bursts of the speech interspersed with 30-second bursts of oddly high-pitched whining from Ryan, with Wolf Blitzer in the foreground shouting seemingly random questions. I saw Anthony Weiner hopping around trying his best to cut through the din but I have no idea what he said.
I read the transcript, and I’d like to try to answer this question:
Indeed, to those in my own party, I say that if we truly believe in a progressive vision of our society, we have the obligation to prove that we can afford our commitments. If we believe that government can make a difference in people’s lives, we have the obligation to prove that it works – by making government smarter, leaner and more effective.
Indeed. I say, too.
Medicare, the public single-payer program, costs too much. We’re paying too much for health care. We’re not getting a good value. The onus is on liberals (because we support universal single payer) to explain what we plan to do about that. If we want to protect Medicare or (wonder of wonders) expand public single-payer, we’re going to have to address this problem. It isn’t going away.
The conservative solution is to simply stop paying for health care past a certain random point. While not paying for health care beyond some arbitrary point is one way to cut costs on health care, we don’t support the conservative solution because it doesn’t address health care costs. It simply shifts them. In some cases it shifts them right out into the parking lot, but that’s still shifting. It’s dodging.
Medicare is a beautiful opening, because it’s a public single payer program. The advantage to that is we don’t have to go off track into the payment mechanisms, like we do when talking (fighting) about the PPACA and the for-profit insurance system. The Medicare payment mechanism is single payer and liberals support universal single payer. We can focus exclusively on health care costs (not insurance costs) when discussing how to save money on Medicare. I know that Medicare Advantage is a privatized portion of Medicare, but Medicare Advantage failed spectacularly as a cost control measure so it doesn’t matter for our discussion. Tried that. It failed.
This is one example of the Medicare cost controls contained within the PPACA:
The next cost control worth mentioning is an effort by Congress to solve the problem of, well, Congress. Medicare’s cost problem is, in many ways, a political problem: Saving money means cutting someone’s profits or someone’s benefits, and politicians are afraid to do either.
Enter the Independent Medicare Advisory Board. Modeled off of the highly respected (but totally toothless) Medicare Payment and Advisory Commission, IMAC is a 15-person board of independent experts chosen by the president, confirmed by the Senate and empowered to cut through congressional gridlock.
IMAC will write reforms that bring Medicare into like with certain spending targets. Congress can’t modify these proposals, it can’t filibuster these proposals, and if it wants to reject them, it needs to find another way to save the same amount of money. Making the process of passing tough reforms easier is the single most important thing you can do to make sure tough reforms actually happen.
Before we start yelling about rationing, let’s leave that to conservatives, and look at the law (pdf).
Here’s the substantive limit:
Prohibited from including any recommendation that would: (1) ration health care; (2) raise revenues or increase Medicare beneficiary premiums or cost sharing; or (3) otherwise restrict benefits or modify eligibility criteria.
In addition, for implementation years through 2019, mandatory proposals cannot include recommendations that would reduce payment rates for providers and suppliers of services scheduled to receive reductions under the ACA below the level of the automatic annual productivity adjustment called for under the Act.1
As a result, payments for inpatient and outpatient hospital services, inpatient rehabilitation and psychiatric facilities, long-term care hospitals, and hospices are exempt from IPAB-proposed reductions in payment rates until 2020; clinical laboratories are exempt until 2016.
These exclusions leave Medicare Advantage, the Part D prescription drug program, skilled nursing facility, home health, dialysis, ambulance and ambulatory surgical center services, and durable medical equipment (DME) as the focus of attention.
It’s gradual, and it starts with the programs that are most vulnerable to for-profit lobbyist…shall we say… input.
And here’s what Congress can do to trump the board:
The Board’s legislative proposal must be introduced by the majority leaders of the House and Senate on the day it is submitted to Congress, and is referred to the appropriate committees. The committees must report those recommendations, with any changes, in just two and one-half months, no later than April 1 of the proposal year, or the proposals are formally discharged from the committees. The committees, and the full House and Senate, cannot consider any amendment that would change or repeal the Board’s recommendations unless those changes meet the same fiscal criteria under which the Board operates.
Congress has to act (“with any changes”) or the recommendations go into effect.
Discuss this law or any other ideas on how control costs in public single-payer health care.