Friday, October 23, 2009

Dana Milbank Takes the Administration to Task on the Medicare Fix

The health care focus has turned to Harry Reid this week; Reid is putting together a version of the legislation on which the entire Senate will vote (probably in the next month or so).

It sounds like Reid is basically incorporating the Baucus bill, but the big news this morning is that he might actually include a public option. This came as a complete surprise to me -- I thought the Baucus committee's omission of the public option was its death knell.

According to Robert Pear and David Herszenhorn in the Times (here), Reid is considering a version of the public option that would allow individual states to opt out. Not surprisingly, the moderates (including Ben Nelson, Mary Landrieu, and Olympia Snowe) are pushing back.

The Times article says that Reid's (potential) change in approach is influenced by polls showing that a large majority of Americans continue to favor a public plan.

I am not at all convinced Reid will actually include a public option in the Senate version of the bill. The polls have shown public support for a public option all year long, and to date that hasn't convinced Reid (or Obama) to really get behind it. I think this is just a tactical move by Reid -- he's putting this story out there, so that then when the opposition by key moderates is too intense he will be able to argue to the liberals, "Sorry -- I tried but it became clear that we couldn't get the 60 votes necessary to include the public option."

The even more interesting development in the health care debate this week was that the Democrats tried to separate out a $247 billion portion of the bill (which is used for increased Medicare payments to doctors) so that they could remain true to Obama's pledge that the bill is revenue neutral.

This is dishonest accounting by the Democrats/Administration, and it really frustrates me. The $247 billion is critical to retaining the support of the American Medical Association, and the Dems need to sack-up and admit that Medicare payments are a critical part of the overall health care structure in the US.

Fortunately, the "separating out" plan is being criticized and it looks like it may not have the votes to pass. Here's Dana Milbank in Wednesday's Post (the full article is here) with a particularly pointed critique:

"I will not sign a plan that adds one dime to our deficits, either now or in the future -- period," President Obama told Congress in a health-care address last month.

Well, that depends on what the meaning of "plan" is.

Senate Democrats wanted to protect doctors from scheduled cuts in Medicare payments over the next 10 years, but there was a problem: Doing so would add a quarter of a trillion dollars to the federal deficit, making mincemeat of Obama's promise. So Democrats hatched a novel scheme: They would pass the legislation separately, so the $250 billion cost wouldn't be part of the main reform "plan," thereby allowing the president to claim that that bill wouldn't increase the deficit.


The sponsor of the doc fix, Sen. Debbie Stabenow (D-Mich.), seemed unconcerned that the fix had put the party in one. "It really is about honest budgeting," she said at a news conference Tuesday morning. On one side of her stood the AMA president. On the other side was a poster framed by a flag. One of its bullet points: "Honest budgeting."

Honestly? A decade ago, Congress passed legislation designed to limit health-care costs by slowing the growth of Medicare payments to doctors. Each year, Congress passes a "patch" to prevent the cuts from taking effect. Stabenow proposed to make this system "honest" by eliminating the cuts permanently.

Medicare is hurtling toward insolvency, but Stabenow would essentially repeal past cost-cutting efforts. And even granting that it's a good idea not to cut Medicare payments to doctors, it's a strange interpretation of honesty to separate this $250 billion cost from the health-care bill and then claim that the other bill doesn't raise the deficit.

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