Commentary Magazine


Topic: Medicare Advisory Board

Highfalutin Words for Slashing Medicare

In the middle of a rant advising Obama to escape the thrall of Wall Street, E.J. Dionne lets this slip out:

Some keep pushing the tired notion that the deficits can be cured if we just reduce “entitlements,” which I put in quotation marks because I’m weary of people using this highfalutin word to dodge saying directly that they want deep cuts in Medicare and Social Security.

What’s that? I believe the folks who want deep cuts in Medicare are Obama, Harry Reid, and Nancy Pelosi. Oh, and the spinners who keep telling us that ObamaCare is wonderful and just needs to be sold to the American people. But what happens when Obama, Reid, and Pelosi are asked about more than $500 billion in Medicare cuts?

Maybe they can trot out Dionne’s line: “Actually, health-care reform is designed in part to contain the long-term growth of Medicare costs.” What does “contain the long-term growth of Medicare costs” mean in plain English? It means paying health-care providers much less, requiring them to ration care. And then the bill will empower the Medicare Advisory Board to figure out more ways to chisel on care.

There’s a reason the bill is unpopular, and especially so among seniors. They aren’t fooled by highfalutin words that amount to the government’s squeezing care for seniors for the sake of achieving “historic” legislation.

In the middle of a rant advising Obama to escape the thrall of Wall Street, E.J. Dionne lets this slip out:

Some keep pushing the tired notion that the deficits can be cured if we just reduce “entitlements,” which I put in quotation marks because I’m weary of people using this highfalutin word to dodge saying directly that they want deep cuts in Medicare and Social Security.

What’s that? I believe the folks who want deep cuts in Medicare are Obama, Harry Reid, and Nancy Pelosi. Oh, and the spinners who keep telling us that ObamaCare is wonderful and just needs to be sold to the American people. But what happens when Obama, Reid, and Pelosi are asked about more than $500 billion in Medicare cuts?

Maybe they can trot out Dionne’s line: “Actually, health-care reform is designed in part to contain the long-term growth of Medicare costs.” What does “contain the long-term growth of Medicare costs” mean in plain English? It means paying health-care providers much less, requiring them to ration care. And then the bill will empower the Medicare Advisory Board to figure out more ways to chisel on care.

There’s a reason the bill is unpopular, and especially so among seniors. They aren’t fooled by highfalutin words that amount to the government’s squeezing care for seniors for the sake of achieving “historic” legislation.

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Re: The Culture of Corruption

Pete, your focus on the fundamental corruption at the heart of the Senate bill is, I think, exactly right and that corruption rather extraordinary. In the days after the Senate cloture vote on the health-care bill, you would think the mainstream media would be touting the bill’s benefits and focusing on the huge “win” for the president. But instead the buzz in both the mainstream and conservative media has not been about the merits of the “historic” legislation but about the backroom deals necessary to achieve its passage, which its sponsors assure us will usher in a wonderful era of improved health-care access and care.

We’re going to remember for years to come the names of the deals, just as surely as did the infamous Bridge to Nowhere become part of the political vocabulary: Louisiana Purchase, Cornhusker Kickback, U Con, Bayh Off, Handout Montana, and Gator Aid. Vermont and Massachusetts got billions more in Medicare funding. Sen. Roland Burris managed to slip in some funding for none other than ACORN, under the guise of improving minority community health. The scope and number of the deals are breathtaking, but it goes beyond the unseemliness of the average pork-barrel bill.

After all, this is not merely a transportation appropriations bill where the whole point is to dole out federal monies and the “game” is for each lawmaker to grab as much of the pie as possible for his own constituents. That might be distasteful to legislative purists and raise doubts as to whether all the money is being wisely spent. But it’s just about spreading the largess. In a case of transportation pork, one district gets a bike path and another doesn’t get the highway off-ramp, but neither district probably needed the project anyway.

In the case of health care, however, the bill rests on the premise that we are improving access to care and working toward a healthier society, reducing the problem of haves and have-nots. For decades that is how health-care “reform” has been sold by liberals.

But instead, what we “get” for health-care sweetheart deals is a new regime of rationed care, which will primarily impact the elderly. The nauseating plethora of backroom deals and special carve-outs for this or that state in health-care “reform,” therefore, is more egregious, and thus more politically toxic.

A central feature of this bill is the $500B cuts in Medicare funding, including slashing the popular Medicare Advantage plan and the imposition of a newly beefed-up Medicare Advisory Board, which will be empowered to devise new ways of cutting payments to doctors, hospitals, nursing homes, and other health-care providers. In the absence of any real reform measures, the only feasible way to control costs is limiting care—i.e., rationing. Medicare already denies medical claims at double the rate of many large private insurers. And with $500B or so less to work with, many more Medicare claims will be denied.

This is what the Cornhusker Kickback and the rest of the bribe-a-thon are enabling. The Senate bill spared voters in a few states the harshest impact of the new care-depriving regime so that the same regime could be foisted on the entire country. Connecticut voters get $600 million in additional Medicaid benefits, Vermont voters get $10B in health-care centers, and hospitals in North Dakota and Iowa get richer Medicare reimbursement rates. Those deals made possible reduced rates of reimbursement and Medicare funding for the rest of the country, rates so paltry and unacceptable to a few key senators that they had to use all their pull to spare their own states. If it is unacceptable for them, why must the rest of the country live with it?

The colorfully named backroom deals may well induce a fiery public backlash, complicating the bill’s passage and negating any political benefit derived by its proponents. Voters will discover not only the ugly side of secret deals; they may also figure out that the moral justification for health care has been jettisoned by those who used their clout to squeeze care for millions of voters while sparing themselves the worst of that backlash.

Pete, your focus on the fundamental corruption at the heart of the Senate bill is, I think, exactly right and that corruption rather extraordinary. In the days after the Senate cloture vote on the health-care bill, you would think the mainstream media would be touting the bill’s benefits and focusing on the huge “win” for the president. But instead the buzz in both the mainstream and conservative media has not been about the merits of the “historic” legislation but about the backroom deals necessary to achieve its passage, which its sponsors assure us will usher in a wonderful era of improved health-care access and care.

We’re going to remember for years to come the names of the deals, just as surely as did the infamous Bridge to Nowhere become part of the political vocabulary: Louisiana Purchase, Cornhusker Kickback, U Con, Bayh Off, Handout Montana, and Gator Aid. Vermont and Massachusetts got billions more in Medicare funding. Sen. Roland Burris managed to slip in some funding for none other than ACORN, under the guise of improving minority community health. The scope and number of the deals are breathtaking, but it goes beyond the unseemliness of the average pork-barrel bill.

After all, this is not merely a transportation appropriations bill where the whole point is to dole out federal monies and the “game” is for each lawmaker to grab as much of the pie as possible for his own constituents. That might be distasteful to legislative purists and raise doubts as to whether all the money is being wisely spent. But it’s just about spreading the largess. In a case of transportation pork, one district gets a bike path and another doesn’t get the highway off-ramp, but neither district probably needed the project anyway.

In the case of health care, however, the bill rests on the premise that we are improving access to care and working toward a healthier society, reducing the problem of haves and have-nots. For decades that is how health-care “reform” has been sold by liberals.

But instead, what we “get” for health-care sweetheart deals is a new regime of rationed care, which will primarily impact the elderly. The nauseating plethora of backroom deals and special carve-outs for this or that state in health-care “reform,” therefore, is more egregious, and thus more politically toxic.

A central feature of this bill is the $500B cuts in Medicare funding, including slashing the popular Medicare Advantage plan and the imposition of a newly beefed-up Medicare Advisory Board, which will be empowered to devise new ways of cutting payments to doctors, hospitals, nursing homes, and other health-care providers. In the absence of any real reform measures, the only feasible way to control costs is limiting care—i.e., rationing. Medicare already denies medical claims at double the rate of many large private insurers. And with $500B or so less to work with, many more Medicare claims will be denied.

This is what the Cornhusker Kickback and the rest of the bribe-a-thon are enabling. The Senate bill spared voters in a few states the harshest impact of the new care-depriving regime so that the same regime could be foisted on the entire country. Connecticut voters get $600 million in additional Medicaid benefits, Vermont voters get $10B in health-care centers, and hospitals in North Dakota and Iowa get richer Medicare reimbursement rates. Those deals made possible reduced rates of reimbursement and Medicare funding for the rest of the country, rates so paltry and unacceptable to a few key senators that they had to use all their pull to spare their own states. If it is unacceptable for them, why must the rest of the country live with it?

The colorfully named backroom deals may well induce a fiery public backlash, complicating the bill’s passage and negating any political benefit derived by its proponents. Voters will discover not only the ugly side of secret deals; they may also figure out that the moral justification for health care has been jettisoned by those who used their clout to squeeze care for millions of voters while sparing themselves the worst of that backlash.

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More Time to Change Minds

Politico is reporting that the White House “privately anticipates health care talks to slip into February” and that “disputes over abortion and the tight schedule are highly likely to delay a final deal, a blow to the president, who had hoped to trumpet a health care victory in his big speech to the nation.” They anticipate that House leaders will roll over and “largely accept the compromise worked out in the Senate.” Well, well.

It seems there is an opportunity then. The details of the shady deals, the abortion funding, the Medicare slashing, and the attempt to insulate the death panels . . . er  Medicare Advisory Board . . .  from potential repeal by a subsequent Congress are only now coming to light. If the next month or so is spent explaining to the public what is in the bill and that it, even by its sponsors’ own terms, fails to meet the goals of deficit reduction and improved access, then perhaps some wary lawmakers’ minds may be changed.

Harry Reid’s effort to jam this through without public scrutiny may fail spectacularly. Senators emboldened by the late-night sessions and the cloak of opaqueness have wheeled and dealed without a second thought. Now the public can tell the lawmakers what they think, and put to the fire the feet of those supposedly “responsible” Democrats who were going to protect taxpayers (but not those with incomes less than $200,000) and the elderly (except for sucking $500B out of an already shaky Medicare system). Time has never been on the side of the Democrats and news that there will be a significant delay, if accurate, comes as a welcomed holiday gift to ObamaCare opponents.

Politico is reporting that the White House “privately anticipates health care talks to slip into February” and that “disputes over abortion and the tight schedule are highly likely to delay a final deal, a blow to the president, who had hoped to trumpet a health care victory in his big speech to the nation.” They anticipate that House leaders will roll over and “largely accept the compromise worked out in the Senate.” Well, well.

It seems there is an opportunity then. The details of the shady deals, the abortion funding, the Medicare slashing, and the attempt to insulate the death panels . . . er  Medicare Advisory Board . . .  from potential repeal by a subsequent Congress are only now coming to light. If the next month or so is spent explaining to the public what is in the bill and that it, even by its sponsors’ own terms, fails to meet the goals of deficit reduction and improved access, then perhaps some wary lawmakers’ minds may be changed.

Harry Reid’s effort to jam this through without public scrutiny may fail spectacularly. Senators emboldened by the late-night sessions and the cloak of opaqueness have wheeled and dealed without a second thought. Now the public can tell the lawmakers what they think, and put to the fire the feet of those supposedly “responsible” Democrats who were going to protect taxpayers (but not those with incomes less than $200,000) and the elderly (except for sucking $500B out of an already shaky Medicare system). Time has never been on the side of the Democrats and news that there will be a significant delay, if accurate, comes as a welcomed holiday gift to ObamaCare opponents.

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Constitution? This Is Health Care!

In his final floor speech before the middle-of-the-night cloture vote, Sen. Mitch McConnell declared, “It’s now clear the majority is willing to do anything to jam through a 2000-page bill before the American people or any of us has had a chance to read it — including changing the rules in the middle of the game.” And as we now comb through those 2,000 pages, it appears that “anything” is not limited to “anything the Constitution allows” or “anything that Congress has ever tried before.”

A case in point is the apparent effort by Senate Democrats to prevent future Congresses from pulling the plug on the noxious death panels … er … the Medicare Advisory Board, without a super-duper majority vote. Sen. Jim DeMint has pointed out that through a mere rule change, the Senate Democrats are trying to impose a 67-vote requirement, which will be nearly impossible to achieve, of course, to knock out the panels in a future Congress. So if for example the controversial mammogram guideline is enacted by the Medicare Advisory Board along with other “effectiveness” measures, there will be little a future Congress can do about it.

A Republican Senate adviser says: “The bill changes some Senate rules to say we can’t vote in a future Congress to repeal the IMAB (death panels). A Senate rules change would require 67 votes for cloture on the bill, but [Senate] parliamentarian decided its a “procedural change” not a “rules change” so they only need 60. … [It makes] no sense.” He says it is still possible to “find a way to kill the death panels even though the bill changes the rules to say we can’t (maybe deny them funding would work, we could change the Senate rule it creates in a later Congress with a 67 senator vote), but it’s clear the health bill changes Senate rules and needs 67 votes for cloture.” We are apparently in a Brave New World of making up Senate rules. The adviser remarks that Senate parliamentarian Alan S. Frumin “seems to be in Reid’s back pocket and is making stuff up to save the bill.”

In a brief survey of other Senate offices and some legal gurus, the initial reaction was the same: “One Congress can’t bind another.” It is at the very least dubious constitutionally and unseemly in the extreme. This is legislative bullying at its worst — rushed, nontransparent, with an anything-will-fly attitude. Once the public gets a whiff of this and the other shenanigans, one can imagine that their already negative reaction to the bill (the latest poll shows that the public disapproves by a 56 to 36 percent margin, and 72 percent don’t want any public money going to subsidize abortions) may turn to rage.

 
 

In his final floor speech before the middle-of-the-night cloture vote, Sen. Mitch McConnell declared, “It’s now clear the majority is willing to do anything to jam through a 2000-page bill before the American people or any of us has had a chance to read it — including changing the rules in the middle of the game.” And as we now comb through those 2,000 pages, it appears that “anything” is not limited to “anything the Constitution allows” or “anything that Congress has ever tried before.”

A case in point is the apparent effort by Senate Democrats to prevent future Congresses from pulling the plug on the noxious death panels … er … the Medicare Advisory Board, without a super-duper majority vote. Sen. Jim DeMint has pointed out that through a mere rule change, the Senate Democrats are trying to impose a 67-vote requirement, which will be nearly impossible to achieve, of course, to knock out the panels in a future Congress. So if for example the controversial mammogram guideline is enacted by the Medicare Advisory Board along with other “effectiveness” measures, there will be little a future Congress can do about it.

A Republican Senate adviser says: “The bill changes some Senate rules to say we can’t vote in a future Congress to repeal the IMAB (death panels). A Senate rules change would require 67 votes for cloture on the bill, but [Senate] parliamentarian decided its a “procedural change” not a “rules change” so they only need 60. … [It makes] no sense.” He says it is still possible to “find a way to kill the death panels even though the bill changes the rules to say we can’t (maybe deny them funding would work, we could change the Senate rule it creates in a later Congress with a 67 senator vote), but it’s clear the health bill changes Senate rules and needs 67 votes for cloture.” We are apparently in a Brave New World of making up Senate rules. The adviser remarks that Senate parliamentarian Alan S. Frumin “seems to be in Reid’s back pocket and is making stuff up to save the bill.”

In a brief survey of other Senate offices and some legal gurus, the initial reaction was the same: “One Congress can’t bind another.” It is at the very least dubious constitutionally and unseemly in the extreme. This is legislative bullying at its worst — rushed, nontransparent, with an anything-will-fly attitude. Once the public gets a whiff of this and the other shenanigans, one can imagine that their already negative reaction to the bill (the latest poll shows that the public disapproves by a 56 to 36 percent margin, and 72 percent don’t want any public money going to subsidize abortions) may turn to rage.

 
 

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