By Ruth Marcus - Washington Post
If youre interested in how to get health-care costs under control the case of the F-22 offers an instructive example.
Huh you say? What does a fighter jet have to do with health care? Nothing of course but it has everything to do with politics which has in our current system a good deal to do with health-care costs.
As I began writing the Senate on Tuesday was debating an amendment to the defense authorization bill that would stop production of the stealth fighter. President Obama wants to end the program. So does his opponent in the presidential election Arizona Republican Sen. John McCain. So did President Bush. So do the defense secretary and the chairman of the Joint Chiefs of Staff.
In 2004 the Pentagon concluded that 183 of the aircraft would be sufficient to meet defense needs. If the amendment passed and the program ends there would be 187 -- at a cost of $65 billion.
And yet in the face of Obamas first veto threat the Senate Armed Services Committee voted to authorize $1.75 billion to purchase seven more planes. The House in its version of the measure inserted a $369 million down payment for a dozen more.
If we cant bring ourselves to make this tough but straightforward decision . . . where do we draw the line? Defense Secretary Robert Gates asked in a recent speech. And if not now when? If we cant get this right -- what on earth can we get right?
Good question. The answer as the unfolding Senate debate made clear is that the F-22 just happens to be built in 44 states. Connecticut Democrat Chris Dodd was on the floor to argue against the amendment; Connecticut-based Pratt & Whitney makes F-22 engines. Just before him was Georgia Republican Saxby Chambliss; Lockheed Martin the F-22s manufacturer does the planes final assembly in Marietta.
Which brings me to health care and one of the most promising ideas for constraining rising costs: Get politics out of the decision making about how much to pay and what to pay for.
The Obama administration which has been ostentatiously hands-off in the drafting of health-care reform has a detailed proposal to create an Independent Medicare Advisory Council to determine payment rates and other policy changes in the health-care program for seniors. The president would have to approve or reject its recommendations as a package after which Congress would have 30 days to reject them.
Democratic Sen. Jay Rockefeller of West Virginia and Rep. Jim Cooper of Tennessee have a similar -- and in important ways stronger -- proposal that the administration also supports. The biggest difference between the two is the number of votes it would take for Congress to block the recommendations: a simple majority in the administrations proposal; three-fifths in the Rockefeller-Cooper plan.
The smart idea behind both is to create a kind of MedPAC on steroids. MedPAC is the Medicare Payment Advisory Commission and the reason it needs boosting lies in its name: advisory. MedPAC routinely offers good recommendations about how to rein in costs; these are just as routinely ignored.
In the world according to MedPAC Medicare would change policies that encourage the purchase of expensive imaging machines. It would increase reimbursements to primary-care physicians and reduce payments to specialists. It would cut overpayments to private Medicare plans that cost on average 14 percent more than regular fee-for-service Medicare -- not that regular fee-for-service Medicare is a model of cost-effectiveness.
Medicare costs matter not just because Medicare consumes such a large and rapidly growing share of government spending. Because Medicare is the 800-pound gorilla of health care its reimbursement policies also drive payment arrangements between private insurers and providers.
Health care is like the F-22 except more so: It affects constituents influential employers and jobs in every congressional district. Draining the politics out of health-care decision making is a first step toward reducing costs.
It is Congresss job to make tough policy choices. Resorting to commissions is generally an admission of a broken political process. But MedPAC on steroids would be different: Its recommendations mostly involve technical questions outside congressional expertise.
Meanwhile at midday Tuesday the Senate voted -- by a surprisingly robust 58 to 40 margin -- to eliminate the F-22 funding. Thats good news -- and not just for more rational defense spending. The politics of health-care make the F-22 fight look simple. It wont be easy to expand coverage in a way that controls costs.
But maybe just maybe the naysayers are premature.
