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Joe Lieberman, Jay Rockefeller, and Sheldon Whitehouse's bid to save the Medicare Commission

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Joe Lieberman's successful effort to tank the public option and Medicare buy-in does not mark the end of his involvement in health-care reform, But his next major initiative is actually good: He's partnered with Jay Rockefeller and Sheldon Whitehouse to save -- and even strengthen -- the Medicare Commission.

As attentive readers will remember, the Medicare Commission lost much of its bite when Reid merged the HELP and Finance bills. Among the biggest problems was that the commission now exempted hospitals for the first decade, contained a provision ending recommendations in 2019 if the rate of growth in Medicare spending fell behind that of private spending (which it often does), and lowered the savings the Commission was tasked with pursuing.

The Rockefeller-Lieberman-Whitehouse amendment repairs these flaws and, in fact, strengthens the Medicare Commission beyond the original proposal. Hospitals are no longer exempted and the language cutting off recommendations in 2019 is deleted entirely. The targeted savings are raised to 1.5 percentage points in 2015 and the schedule for Congress to consider the annual recommendations is moved up from August to June.

Then the proposal takes two big steps forward. First, the Commission is currently charged with submitting recommendations only in years when Medicare's growth rate exceeds the target. Now, it will have to submit a recommendation package in all years, "to clarify that the purpose of the Board is not simply to cut costs, but also to implement changes to the Medicare program that will strengthen and improve it for years to come." That's important: It ensures the Commission has a role in quality, rather than just cost. Though it's important to make Medicare cheaper, it's also important to make it better.

Second, the Medicare Commission is also empowered to offer recommendations that are applicable to the private sector, and the Secretary of Health and Human Services will have the power to apply these changes to plans operating within the health insurance exchanges. That gives the Medicare Commission a foot into the exchanges, which is sensible given that the taxpayer will be on the hook for subsidies within the exchanges.

Taken together, these recommendations would be a huge step forward for cost control in the bill. It's a shame that Lieberman mounted his most aggressive stand against the public option rather than in favor of this proposal, but even so, Rockefeller, Whitehouse, and Lieberman are all pushing in the right direction here. Whether other senators support this amendment will say a lot about how committed they actually are to controlling costs.

Photo credit: AP Photo/Harry Hamburg.

By Ezra Klein  |  December 16, 2009; 8:01 AM ET
Categories:  Health Reform  
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Next: A bailout for insurers?

Comments

I hope they succeed strengthening this commission since the bill needs more serious cost and quality controls. As far as Lieberman's assault on the public option and medicare buy-in, I think that he may be covering for some of his "moderate" allies. Senators Lincoln, Landrieu, Pryor, etc were caught between their base and a more conservative electorate with the PO. If they voted for the PO, they might lose conservative Dems, if they voted against the PO they would depress the Dem base. Lieberman is acting as though he has nothing to lose at this point. I wonder if he has decided not to run for re-election?

Posted by: marvyT | December 16, 2009 8:29 AM | Report abuse

This proposed strengthening is most likely a strategy of getting the weaker version of the Commission into the merged bill. Its hard to see a strong Commission staying in the final bill. The Senate is going to force Pelosi to swallow a bill sans Public Option, she'll want something in return: unfortunately, a weak or no Commission is high on the list.

Posted by: wisewon | December 16, 2009 8:41 AM | Report abuse


will the CBO score this part? Could they be doing some sandbagging because they got a peek at the score already and it costs/doesn't save as much as hoped?

Posted by: ThomasEN | December 16, 2009 8:50 AM | Report abuse

This is a good amendment.

Nevertheless, Lieberman is still a jerkface. I've been really impressed with Rockefeller, though - he's consistently been fighting to make the bill stronger in any way he can.

Posted by: madjoy | December 16, 2009 8:57 AM | Report abuse

Great. Lieberman trying to do good on a bill he plans to obstruct. Irony is thick as fleas in the US Senate.

Posted by: arnold104 | December 16, 2009 9:08 AM | Report abuse

In today's display of left-wing stupidity, Klein accues Lieberman of crucifying Jesus and using the blood of little Christian babies for Passover matzoh.

Tomorrow, Klein asks: is Lieberman really Hitler's reincarnation?

Posted by: WashingtonDame | December 16, 2009 9:35 AM | Report abuse

Taking the bait from the troll above, I'd say that this is a sign that appeasement is working. This would be a huge get on the cost control side. Makes for good PR for the conservative Dems (and maybe Snowe), who can now put out statements about how they fought the liberals and won on cost control so NOW they can support the bill. Not sure that'll happen, but I can hope.

Posted by: etdean1 | December 16, 2009 10:02 AM | Report abuse

I agree etdean1, this is good for the bill and good PR. Hopefully it will, at the very least, solidify moderate Dem senators in their support of the bill.

This doesn't even bring me close to forgiving Leiberman for killing the public parts of the bill, but I have to give credit when someone does something good. Who knows, maybe the next step is expanding the exchanges earlier than planned and to more people? That would also be a good thing.

I know I shouldn't, but I can't resist troll bait...
WashingtonDame: 1) You know this is a positive post about Leiberman, right? and 2) You know Ezra's Jewish, right?

Posted by: MosBen | December 16, 2009 10:12 AM | Report abuse

When could this amendment be voted on?

Posted by: matthewyoungblood | December 16, 2009 10:23 AM | Report abuse

"But his next major initiative is actually good"

No, it isn't. It's terrible! As a liberal I am shocked and appalled at Lieberman's betrayal. If this amendment passes, I will gnash my teeth and rend my hair when reflecting on Lieberman's perfidy. How could he do this to us!!??!?!*

* http://www.eschatonblog.com/2009/12/negotiating.html

Have we learned nothing?

Posted by: FearItself | December 16, 2009 11:13 AM | Report abuse

Just asking: Assuming 60 votes, why not go ahead and pass the current legislation now?

THEN....

Once passed, create another bill that contains the disputed public option or Medicare expansion, along with other disputed progressive ideas, that would qualify for a separate, 51-vote reconciliation adoption?

Posted by: jgau4 | December 16, 2009 11:30 AM | Report abuse

I agree with marvyT that Lieberman is probably providing cover for some of the vulnerable moderate Dems. Given this amendment, perhaps his aim is to maintain the integrity of Medicare, which could have been compromised by allowing younger folks to buy into it.

Posted by: Beagle1 | December 16, 2009 3:43 PM | Report abuse

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