First of all, let’s see what MEDPAC is. From their site:
The Medicare Payment Advisory Commission (MedPAC) is an independent Congressional agency established by the Balanced Budget Act of 1997 (P.L. 105-33) to advise the U.S. Congress on issues affecting the Medicare program. The Commission’s statutory mandate is quite broad: In addition to advising the Congress on payments to private health plans participating in Medicare and providers in Medicare’s traditional fee-for-service program, MedPAC is also tasked with analyzing access to care, quality of care, and other issues affecting Medicare.The Commission’s 17 members bring diverse expertise in the financing and delivery of health care services. Commissioners are appointed to three-year terms (subject to renewal) by the Comptroller General and serve part time. Appointments are staggered; the terms of five or six Commissioners expire each year. For more information on the commissioner appointment process, please clickhere. The Commission is supported by an executive director and a staff of analysts, who typically have backgrounds in economics, health policy, public health, or medicine.
Now, the prevailing theory that pretty much underlines this entire story is that as MEDPAC goes, so goes the nation. Jay Rockefeller is supposedly pondering moving MEDPAC into the Executive Branch to give it the authority to actually establish policy as opposed to merely recommending policy to Congress and allowing Congress to implement it or not. Ezra Klein seems to think this is a most excellent idea:
But this is the first time, at least to my mind, that we’ve seen anything that actually looks able to deliver on controlling costs. To flip the old line, this is where health care reform becomes entitlements reform.
Now, the primary assumption Klein makes is that Congress is ill-suited to handle the complexities of issues MEDPAC addresses. I’m not sure exactly what Klein thinks would be the ideal person to address all the complexities of health care provision. But, he seems to think MEDPAC has it under control. So, I thought I’d take a look at what it takes to be someone so incredible they obviously have more wisdom than HHS, Congress, and the private health industry combined. Without further ado, the MEDPAC advisory board:
- Christine Bechtel, Washington, D.C. (3 year term), Vice President, National Partnership for Women & Families
- Arthur Davidson, M.D., Denver Colorado (2 year term), Denver Public Health Department; Director, Public Health Informatics; Director, Denver Center for Public Health Preparedness; Medical epidemiologist; Director, HIV/AIDS Surveillance, City and County of Denver
- Adam Clark, Ph.D., Austin, Texas (1 year term), Director of Research and Policy, Lance Armstrong Foundation;
- Marc Probst, Salt Lake City, Utah (3 year term), Chief Information Officer, Intermountain Healthcare
- Paul Tang, M.D., Mountain View, California (2 year term); Vice President and Chief Medical Information Officer, Palo Alto Medical Foundation;
- Scott White, New York City, New York (1 year term); Assistant Director, Technology Project Director, 1199 SEIU Training and Employment Fund; Expert in Health Information Privacy & Security
- LaTanya Sweeney, Ph.D., Pittsburgh, Pennsylvania (3 year term); Director, Data Privacy Lab, Associate Professor of Computer Science, Technology and Policy, Carnegie Mellon University; Expert in Improving the Health of Vulnerable Populations
- Neil Calman, M.D., New York City, New York (2 year term); President and CEO, The Institute for Family Health, Inc.
- Connie Delaney, R.N., Ph.D., Minneapolis, Minnesota (1 year term); Dean, School of Nursing, University of Minnesota
- Charles Kennedy, M.D., Camarillo, California (3 year term); Vice President, Health Information Technology, Wellpoint, Inc.
- Judith Faulkner, Verona, Wisconsin (2 year term); Founder, CEO, President, Chairman of the Board, Epic Systems Corporation
Can someone out there tell me exactly why they think someone who’s sole mission is to represent the interests of unions is qualified to determine medical benefits and cost containment for the entire country? Can someone show me when a union has ever come up with a plan to contain costs? And, although this is supposed to be monitoring Medicare, several members are employed exclusively in the for-profit sector. Bottom line from this list, it’s a bunch of people selected by the President solely for the benefit of the President. There is no guarantee whatsoever these are the most qualified people in the country to determine pricing for a multi-billion dollar industry. In other words, it’s probably a good thing Congress takes their recommendations with a grain of salt. It’s probably a good thing that there’s a check in place for MEDPAC. And, here’s a list of who those members would be that provide a balance to the recommendations of MEDPAC currently:
- John Boozman
- Charles Boustany
- Michael Burgess
- Paul Broun
- Bill Cassidy
- John Fleming
- Phil Gingrey
- John Linder
- Tim Murphy
- Ron Paul
- Tom Price
- Phil Roe
- Mike Simpson
That’s just the Republican side. There’s more. I particularly partake of the medical interests espoused by the Rural Health Care Coalition. Medical needs in rural areas are a lot different than in urban areas. We just don’t have as many resources. Here’s a list of who sits on that caucus:
- Rep. Earl Pomeroy (D-ND)
- Rep. Greg Walden (R-OR)
- Rep. Neil Abercrombie (D-HI)
- Rep. Paul Gillmor (R-OH)
- Rep. James Oberstar (D-MN)
- Rep. Mike Arcuri (D-NY)
- Rep. Virgil Goode (R-VA)
- Rep. John Olver (D-MA)
- Rep. Robert Aderholt (R-AL)
- Rep. Bob Goodlatte (R-VA)
- Rep. Solomon Ortiz (D-TX)
- Rep. Rodney Alexander (D-LA)
- Rep. Bart Gordon (D-TN)
- Rep. Ron Paul (R-TX)
- Rep. Tom Allen (D-ME)
- Rep. Sam Graves (R-MO)
- Rep. Steve Pearce (R-NM)
- Rep. Brian Baird (D-WA)
- Rep. Ralph Hall (D-TX)
- Rep. Collin Peterson (D-MN)
- Rep. Richard Baker (R-LA)
- Rep. Phil Hare (D-IL)
- Rep. John Peterson (R-PA)
- Rep. Tammy Baldwin (D-WI)
- Rep. Mazie Hirono (D-HI)
- Rep. Thomas Petri (R-WI)
- Rep. Gresham J. Barrett (R-SC)
- Rep. Alcee Hastings (D-FL)
- Rep. Charles Pickering (R-MS)
- Rep. Roscoe Bartlett (R-MD)
- Rep. Doc Hastings (R-WA)
- Rep. Earl Pomeroy (D-ND)
- Rep. Joe Barton (R-TX)
- Rep. Robin Hayes (R-NC)
- Rep. Adam Putnam (R-FL)
- Rep. Marion Berry (D-AR)
- Rep. Wally Herger (R-CA)
- Rep. Nick Rahall (D-WV)
- Rep. Rob Bishop (R-UT)
- Rep. Stephanie Herseth (D-SD)
- Rep. Dennis Rehberg (R-MT)
- Rep. Sanford Bishop (D-GA)
- Rep. Brian Higgins (D-NY)
- Rep. Rick Renzi (R-AZ)
- Rep. Earl Blumenauer (D-OR)
- Rep. Baron Hill (D-IN)
- Rep. Harold Rogers (R-KY)
- Rep. John Boozman (R-AR)
- Rep. Maurice Hinchey (D-NY)
- Rep. Mike Rogers (R-MI)
- Rep. Dan Boren (D-OK)
- Rep. Ruben Hinojosa (D-TX)
- Rep. Mike Ross (D-AR)
- Rep. Leonard Boswell (D-IA)
- Rep. Pete Hoekstra (R-MI)
- Rep. Paul Ryan (R-WI)
- Rep. Rick Boucher (D-VA)
- Rep. Darlene Hooley (D-OR)
- Rep. Tim Ryan (D-OH)
- Rep. Allen Boyd (D-FL)
- Rep. Kenny Hulshof (R-MO)
- Rep. John Salazar (D-CO)
- Rep. Nancy Boyda (D-KS)
- Rep. Sheila Jackson-Lee (D-TX)
- Rep. Carol Shea-Porter (D-NH)
- Rep. Kevin Brady (R-TX)
- Rep. Timothy Johnson (R-IL)
- Rep. John Shimkus (R-IL)
- Rep. Virginia Brown Waite (R-TX)
- Rep. Walter Jones (R-NC)
- Rep. Bill Shuster (R-PA)
- Rep. Dave Camp (D-MI)
- Rep. Paul Kanjorski (D-PA)
- Rep. Mike Simpson (R-ID)
- Rep. Shelly Moore Capito (R-WV)
- Rep. Marcy Kaptur (D-OH)
- Rep. Ike Skelton (D-MO)
- Rep. Dennis Cardoza (D-CA)
- Rep. Dale Kildee (D-MI)
- Rep. Louise Slaughter (D-NY)
- Rep. Christopher Carney (D-PA)
- Rep. Ron Kind (D-WI)
- Rep. Adrian Smith (R-NE)
- Rep. John Carter (R-TX)
- Rep. John Kline (R-MN)
- Rep. Lamar Smith (R-TX)
- Rep. Ben Chandler (D-KY)
- Rep. Steve King (R-IA)
- Rep. Vic Snyder (D-AR)
- Rep. Donna Christensen (D-VI)
- Rep. Ray LaHood (R-IL)
- Rep. John Spratt (D-SC)
- Rep. James Clybrun (D-SC)
- Rep. Rick Larson (D-WA)
- Rep. Pete Fortney Stark (D-CA)
- Rep. Tom Cole (R-OK)
- Rep. Tom Latham (R-IA)
- Rep. Cliff Stearns (R-FL)
- Rep. Michael Conaway (R-TX)
- Rep. Jerry Lewis (R-CA)
- Rep. Bart Stupak (D-MI)
- Rep. Jim Cooper (D-TN)
- Rep. John Lewis (D-GA)
- Rep. John Tanner (D-TN)
- Rep. Jerry Costello (D-IL)
- Rep. Ron Lewis (R-KY)
- Rep. Gene Taylor (D-MS)
- Rep. Robert Cramer (D-AL)
- Rep. Frank Lucas (R-OK)
- Rep. Lee Terry (R-NE)
- Rep. Barbara Cubin (R-WY)
- Rep. Donald Manzullo (R-IL)
- Rep. Bernie Thompson (D-MS)
- Rep. Arthur Davis (D-AL)
- Rep. Jim Marshall (D-GA)
- Rep. Mike Thompson (D-CA)
- Rep. Danny Davis (D-IL)
- Rep. Jim Matheson (D-UT)
- Rep. Mac Thornberry (R-TX)
- Rep. Jo Ann Davis (R-VA)
- Rep. Jim McCrery (R-LA)
- Rep. Todd Tiahrt (R-KS)
- Rep. Lincoln Davis (D-TN)
- Rep. Jim McDermott (D-WA)
- Rep. Ed Towns (D-NY)
- Rep. Nathan Deal (R-GA)
- Rep. James McGovern (D-MA)
- Rep. Michael Turner (R-OH)
- Rep. Peter DeFazio (D-OR)
- Rep. John McHugh (R-NY)
- Rep. Tom Udall (D-NM)
- Rep. William Delahunt (D-MA)
- Rep. Mike McIntyre (D-NC)
- Rep. Fred Upton (R-MI)
- Rep. Lloyd Doggett (D-TX)
- Rep. Buck McKeon (R-CA)
- Rep. Peter Visclosky (D-IN)
- Rep. John Doolittle (R-CA)
- Rep. Michael McNulty (D-NY)
- Rep. Greg Walden (R-OR)
- Rep. Thelma Drake (R-VA)
- Rep. Cathy McMorris (R-WA)
- Rep. Jim Walsh (R-NY)
- Rep. Chet Edwards (D-TX)
- Rep. Charlie Melancon (D-LA)
- Rep. Tim Walz (D-MN)
- Rep. Vernon Ehlers (R-MI)
- Rep. Michael Michaud (D-ME)
- Rep. Zach Wamp (R-TN)
- Rep. Jo Ann Emerson (R-MO)
- Rep. Brad Miller (D-NC)
- Rep. Peter Welch (D-VT)
- Rep. Bob Etheridge (R-MI)
- Rep. Jeff Miller (R-FL)
- Rep. Jerry Weller (R-IL)
- Rep.Eni Faleomavaega (D-AS)
- Rep. Alan Mollohan (D-WV)
- Rep. Ed Whitfield (R-KY)
- Rep. Mary Fallin (R-OK)
- Rep. Jerry Moran (R-KS)
- Rep. Roger Wicker (R-MS)
- Rep. Jeff Fortenberry (R-NE)
- Rep. John Murtha (D-PA)
- Rep. Charles Wilson (D-OH)
- Rep. Randy Forbes (R-VA)
- Rep. Marilyn Musgrave (R-CO)
- Rep. Heather Wilson (R-NM)
- Rep. Gabrielle Gifford (D-AZ)
- Rep. Randy Neugebauer (R-TX)
- Rep. Joe Wilson (R-SC)
- Rep. Wayne Gilchrest (R-MD)
- Rep. Charlie Norwood (R-GA)
- Rep. Don Young (R-AK)
- Rep. Kirsten Gillibrand (D-NY)
- Rep. Devin Nunes (R-CA)
You’ve got doctors, you’ve got nurses, you’ve got every conceivable social demographic covered. That’s another 175 people with some degree of experience or concern about health care. And, what I like even better about this list than the first one?
We picked the second list.
Obama is pulling too much authority into the Executive Branch. He’s not doing it at the expense of Congress, he’s doing at the expense of your right to choose. If Medicare were a panacea of medical coverage, I would be more receptive. But, if you ask any medical provider who the worst payor is, I bet you bottom dollar Medicare would win out by a long shot. Many providers have pulled out of Medicare over the last few years due to their dragging out claims, challenging inane paper errors, and just being a bugger to deal with. That’s not cost containment as we need it. That’s cost containment at the expense of coverage. That’s the national plan you see unfolding for Obama’s health plan.
And, just for Ezra, as a provider, I can tell you from experience, when preparing rates for Medicare, you round UP, not DOWN. The reason being is Medicare only pays for a certain dollar amount that you can maximize. Additionally, most private sector insurers will not pay more than the Medicare amount. So, if you accept Medicare, and you do private business as well, you’d be nuts to charge Medicare anything less than slightly more than the maximum rate they offer. The trade-off? It allows you to discount the private sector, primarily those with poor or no insurance.
Those are the ones who will get hit the worst under Rockefeller’s scenario, which should be noted, is not on ANY of the lists above. If the Medicare rates are lowered, that leaves less margin to cover for those people. All they could hope for at that point is for the standards that denied them coverage under Medicare in the first place to be changed as well.
That, I would not rule out. You can’t have a perfect socialist utopia with out socialized medical care.
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