I've seen a ton of misinformation about this issue, I guess the far left not wanting to be outdone by the far right in the fear mongering department has found it's equivalent to death panels. Ezra wrote a couple articles over the summer explaining the issue and it has nothing to with trying to privatize Social Security or Medicare
You probably haven't heard of MedPAC. Most people haven't. It stands for The Medicare Payment Advisory Commission and it's an independent congressional agency formed in 1997 to advise the Congress on matters relating to Medicare. The commission is staffed by experts who are appointed for three-year terms, and its existence is due to a simple insight: Medicare payment policy is too technical for the Congress. There aren't five senators with an informed opinion on the "equipment use standard" for imaging machines, much less 50, and much less 100.
Every year, MedPAC releases a "report to the Congress on Medicare payment policy." The report contains acres of analysis (this year's "assessing payment adequacy and updating payments in fee-for-service Medicare" was particularly thrilling) and a final chapter on recommendations. The recommendations tend to be smart, aggressive, reforms. The sort of reforms experts agree are needed, but interest groups effortlessly stymie. The recommendations don't, in other words, matter. None of it does, really. The report sits on a shelf.
But what if it didn't? What if MedPAC had power?
{snip}
And that's how some in the White House would prefer it. The health system changes too quickly for Congress to address through massive, infrequent, efforts at total reform. New technologies and new care structures create new problems. A health care reform package signed in 2009 might miss some real deficiencies, or real opportunities, that present themselves in 2012. A health reform process that recognizes that fact is a health reform process that is continual, rather than episodic.
But the reason health reform is so infrequent is that it's structurally difficult. Small tweaks are too technically complex for Congress to easily conduct and so are dominated by lobbyists. Large reforms attract broad interest but are impeded by polarization and the threat of the filibuster. The MedPAC changes under discussion are, in other words, nothing less than a new process for health care cost reforms. They empower experts who won't be intimidated by the intricacy of the issues and sidestep the filibuster's ability to halt change in its tracks.
MedPAC, of course, is restricted to Medicare. But there's little doubt that where Medicare leads, the health care industry follows. Private insurers frequently set their prices in relation to Medicare's payment rates. Hospitals are sufficiently dependent on Medicare that a reform instituted by the entitlement program becomes a de facto change for the whole institution, and thus all patients. A process that empowers Medicare to aggressively and fluidly reform itself would end up dramatically changing the face of American health care in general.
http://voices.washingtonpost.com/ezra-klein/2009/06/breaking_how_the_white_house_p.htmlThe main congressional legislation on this issue is Sen. Jay Rockefeller's MedPAC Reform Act. Rockefeller would transform MedPAC into an executive branch agency that would act much like a Federal Reserve for Medicare: Commissioners would be confirmed by Congress for six-year terms and their recommendations would be automatically implemented.
The worry of the White House -- and some others -- is that there is good reason that Medicare should not be taken fully from Congress. The program's revenue, after all, flows through the Finance Committee. The program's constituents -- not just industry, but seniors -- have an active, and occasionally even productive, relationship with the legislative branch. And though monetary policy has substantial effects on individual lives, its inherent complexity tends to discourage popular attention. There are very few street protests that are explicitly about interest rate cuts. Not so for Medicare. Health care is very personal.
But that has gone too far. Medicare is effectively frozen. For a long version of this argument, read Bob Berenson and Len Nichols' argument in Making Medicare Sustainable. Last night, I spoke with Nichols, however, and he put it more pithily: "The thing I'd say about the whole genre of proposals in this area is that it's really about empowering information and science and evidence over lobbying. Everything else is a device to make that happen."
"The members of the Finance Committee now who have been there a long time get this," continues Nichols. "They know the Center for Medicare and Medicaid Services does their due diligence and takes their public reporting responsibilities seriously and that device manufacturers present their case to CMS and frequently lose. And when they lose, they come to Congress and get friendly senators to sponsor an amendment and overturn CMS's rules. Every member of finance has seen this hundred times."
This proposal is about stopping time 101 from happening. The key feature of a defense base-style commission (a "BRAC" commission), is that the proposal that goes to Congress cannot be changed. You have to vote for, or against, the whole document. For or against all the recommendations at once. You can't take out the one provision that your hometown device manufacturer didn't like. That raises the stakes. The choice stops being whether you support skinning that one hometown prosthetics makers and becomes whether you support the national need for deficit reduction and health care reform or the parochial interests of the one manufacturer in your hometown. This doesn't guarantee good behavior from Congress, of course, but it makes it more likely.
http://voices.washingtonpost.com/ezra-klein/2009/06/how_obama_plans_to_reform_medi.html
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