Obama Wants MedPAC on Steroids (Oh, and the Public Plan, too)

Even when he's halfway around the world, President Obama is fully capable of driving the health care debate. After months of statements of support for health care that have become increasingly general and vague, the president sent a letter to Sen. Kennedy and Sen. Baucus, the twin head honchos of the Senate on health care reform. With his embrace of the public plan and his new desire for a “MedPAC on steroids”, he’s reshaped the political debate in Washington – at least for today.

Although Mark Helperin on TIME’s The Page calls this letter “The Rosetta Stone,” it’s not particularly cryptic, nor is it, for the most part, surprising. Obama expounds on the need for cost control as always, expresses support for what Kennedy and Baucus have cooking (which is 95% the same as what he himself proposed during the campaign) and gives full support for both a National Health Exchange and a public health insurance option:

The plans you are discussing embody my core belief that Americans should have better choices for health insurance, building on the principle that if they like the coverage they have now, they can keep it, while seeing their costs lowered as our reforms take hold. But for those who don't have such options, I agree that we should create a health insurance exchange -- a more market where Americans can one-stop shop for a health care plan, compare benefits and prices, and choose the plan that's best for them, in the same way that Members of Congress and their families can. None of these plans should deny coverage on the basis of a preexisting condition, and all of these plans should include an affordable basic benefit package that includes prevention, and protection against catastrophic costs. I strongly believe that Americans should have the choice of a public health insurance option operating alongside private plans. This will give them a better range of choices, make the health care market more competitive, and keep insurance companies honest.

He could have written that months ago. It’s only noteworthy because it reverses a trend of getting less and less specific about what he wants. Now, after months of saying I thought there should be a public plan but he was open to other ideas, we get the far clearer statement, “I strongly believe.”

But really, the much bigger news is the fact that Obama’s letter also calls for MedPAC to follow in the footsteps of Manny Ramirez (allegedly) to become “MedPAC on steroids.” MedPAC has nothing to do with lobbyists or campaign funds. It stands for Medicare Payment Advisory Commission, and it was actually created once upon a time by a Newt Gingrich-dominant Congress so that experts in the field of health care – doctors, nurses, economists, health care experts, managers of hospitals and other care facilities – could make recommendations on what Medicare should be paying for, and give analysis on access to care and quality of care. It releases two reports each year, but right now the reports are completely advisory. Meaning if they advise difficult choices to dramatically control costs and improve care – as they usually do – they can be easily ignored.

Just to be clear, we’re not talking about a bunch of lifelong politicians and bureaucrats gathering in a room. Look at the current board of MedPAC and you’ll see 6 doctors, 3 PhDs, 2 MPHs, 2 lawyers, a nurse, and a diverse background including economists, medical school faculty, etc. These guys ain’t playin’, and neither do their recommendations. It’s not a perfect board – it tilts somewhat in favor of specialists over primary care – but it has far more knowledge of the ins and outs of health care than Congress has or is likely to get.

So the question Obama is now pushing (and which was pushed before him by Sen. Jay Rockefeller) is why are allowing great ideas about reforming Medicare to be so easy to ignore? Let’s not forget that Medicare is the Big Dog of American health care – when it sets rates, tries out new models, or implements new efficiencies for itself, the industry as a whole, public and private, usually implements the most successful initiatives. But, as Rockefeller says, “Congress has proven itself to be inefficient and inconsistent in making decisions about provider reimbursement under Medicare. If we want serious improvements in our health care delivery system, then we need to reform MedPAC’s current authority to include fully establishing and implementing Medicare reimbursement rules.”

Rockefeller would make MedPAC an official Executive Branch agency like the Federal Reserve Board. But President Obama seems to be offering a different idea: “MedPAC's recommendations on cost reductions would be adopted unless opposed by a joint resolution of the Congress. This is similar to a process that has been used effectively by a commission charged with closing military bases, and could be a valuable tool to help achieve health care reform in a fiscally responsible way.” The reason why the base-closing commissions of the 1990s to today work is that they take the politics out of the decision: it’s no longer about which Congressman’s district is about to lose 20,000 jobs, it’s about which bases actually support the missions of our modern military. Setting up an auto-acceptance mechanism to reform Medicare is going to be fraught with other political issues, which is why it so desperately needs to be taken away from politicians who know more about politics than they do medicine and into the hands of experts who know our health care system better than they do politics. Congress still has the option to stop it, but it has to be yes or no on the whole package – no picking and choosing.

This is arguably the most important to new idea that the president has pushed to date. It’s not just enough to just give everyone access to insurance or to Medicare. After all, New Yorker writer Dr. Atul Gawande’s example of out-of-control costs in McAllen, Texas is a story that’s only about Medicare. If we “juice up” a board that’s already giving good advice on reforming Medicare, we’ll go a long way towards fixing the system for everyone.

(Photo credit:  The Official White House Photostream on Flickr.)