Peeling The “Health Care Reform” Onion – Power, Politics and Democrats

There are a number of things going on in the health care reform debate that are the reason Democrats are at odds with each other. One, obviously is cost. What should be apparent, even to rocket scientists like Nancy Pelosi, is that the American people are not buying into the premise that “government can expand coverage, improve care and do it for less”. It’s not happening.

And, of course, those on the blue side that are leading the “no way, no how” charge are the so called Blue Dogs. Bolstering the Blue Dog position is the CBO, or Congressional Budget Office – a non-partisan organization which “scores” proposed bills for cost and savings. In the last few weeks it has consistently found Democratic Congressional legislative proposals wanting – pointing out none delivered the promised savings over the long haul.

Predictably, the CBO has come under fire from the left, and yesterday the White House joined the fray. Peter Orszag, the White House budget director, Peter Orszag said – carefully – that the CBO’s recent analysis might be feeding a perception that its tendency is toward “exaggerating costs and underestimating savings.”

Given how the costs of most government programs skyrocket after implementation, I’m having difficulty buying into this supposed perception. And it may say more about Orszag, former CBO director, than it does about the CBO now.

However, what Orszag is talking about specifically is a proposal that is another part of the infighting going on among Democrats.

“The point of the proposal … was never to generate savings over the next decade,” Orszag said in a letter posted on Saturday.

“Instead the goal is to provide a mechanism for improving quality of care for beneficiaries and reducing costs over the long term.”

In fact, the proposal is about shifting power from Congress to the Executive Branch:

The new council, if approved, would replace the current Medicare Payment Advisory Commission, which is made up of doctors and health care experts. Once a year, it gives recommendations about coverage and reimbursement rates for Medicare but has no authority to enforce its ideas. Its report in March recommended that payments for primary care physicians be increased and home health services rates be decreased.

The proposed council would be comprised of doctors and health care experts making their recommendations based on extensive data and analysis of best health care practices, according to administration officials.

It would be an independent executive branch agency — which would give its recommendations more weight. The president would have to approve or disapprove the its recommendations as a package. If it is approved, the package would be enacted if Congress did not vote against it within 30 days.

This isn’t necessarily about “best health care practices” – this is about centralizing the decision making and making it harder and harder for Congress as a whole and individual Congressmen specifically, from excepting their district or certain constituent health care providers from some of the provisions. The White House wants to take that little perk away from them. And that’s another one of many stuggles going on within this fight to pass something.

A Democratic president trying to take power away from a Democratic congress is probably not the best way to try to pass something that the President can call “health care reform”. That’s not to say I support this council in either form – its more to point out how clumsily this administration is proceeding in all of this. If you want legislation passed so your signature issue doesn’t fail, it may be best not to try to take power away from a friendly Congress and take it yourself. Executive power grabs don’t just happen in the national security area as the Democrats constantly criticized Bush for attempting. They can occur in many other areas. We’ll see if the Dems will be as critical of this power grab as they were of the ones alleged of the previous administration.

[Crossposted at QandO]

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