Perhaps most important, the legislation creates an Independent Payment Advisory Board, a panel of independent medical experts who will look for more ways to improve Medicare’s cost-effectiveness. Under the law, any policy that the board issues takes effect unless legislation to block it is passed by Congress and signed by the president. This way, inertia works in favor of cost containment rather than against it.
• By January 15 each year, the Independent Payment Advisory Board must submit a proposal to Congress and the president for reaching Medicare savings targets in the coming year. The majority leaders in the House and Senate must introduce bills incorporating the board’s proposal the day they receive it.
• Congress cannot “consider any bill, resolution, amendment, or conference report … that would repeal or otherwise change the recommendations of the board” if such changes fail to meet the board’s budgetary target.
• By April 1, the committees of jurisdiction must complete their consideration of the proposal. Any committee that fails to meet the deadline is barred from further considering the bill.
• The secretary of health and human services must implement the Independent Payment Advisory Board’s proposal, as passed by Congress and signed by the president, on August 15 of the year in which the proposal is submitted.
• If Congress does not pass the proposal or a substitute plan meeting the Independent Payment Advisory Board’s financial target before August 15, or if the president vetoes the proposal passed by Congress, the original Independent Payment Advisory Board recommendations automatically take effect.
Here, Orszag marvels at the IPAB's "enormous" degree of power to identify and achieve "aggressive" cost-cutting targets. He chuckles about how little power Congress retains in the matter, reminding the audience that Congressional Democrats were fully aware that they were ceding this authority to federal bureaucrats when they passed the legislation. (Incidentally, this also lays bare the utter hypocrisy of Harry Reid's recent opposition to an earmarks ban, which he says is based upon the principle of protecting Congressional power vis-a-vis the executive branch. Reid on 11/16/10: "[The earmarks moratorium] just gives more power to the executive. I'm not one who believes in that.")
Considering Democrats' control of the US Senate and the current occupant of the Oval Office, these requirements make it virtually impossible for Congress to overrule the panel's recommendations. Orszag described the new process with even greater candor during an April appearance at the Economic Club of Washington, DC:
Guy Benson is Townhall.com's Political Editor. Follow him on Twitter @guypbenson. He is co-authors with Mary Katharine Ham for their new book End of Discussion: How the Left's Outrage Industry Shuts Down Debate, Manipulates Voters, and Makes America Less Free (and Fun).
Author Photo credit: Jensen Sutta Photography
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