THE TREATMENT DECEMBER 4, 2009
This morning, three key moderates--Republican Susan Collins, Independent Joe Lieberman, and Democrat Arlen Specter--announced the introduction of a cost-containment amendment to the health-care bill that sent a promising signal about their desire to support the overall Senate bill. The announcement was the strongest indication yet that Collins is a gettable vote and that Lieberman is more persuadable than he previously signaled. Describing the amendment as a “tri-partisan effort,” Collins described the overall bill as containing “a number of promising ideas” that they were hoping to bolster. Their amendment offered some changes that could actually improve--not water down--the reform effort, in part by strengthening the hand of government. At a press conference today, the three Senators described the measure’s five main provisions:
1) Improve transparency and availability of physician quality reporting data by setting up a website for comparison shopping, rewarding Medicare beneficiaries if they use doctors “deemed to be high-performing in a cost-effective way according to these reports,” Lieberman said.
2) Strengthen reporting requirements for insurance companies to increase transparency for consumers, requiring them to publish how many claims were denied and how many denials were overturned.
3) Improve the provisions penalizing hospitals who have the most hospital-acquired infections, doubling the penalty from 1% to 2% of their Medicare reimbursements from the government and moving up the start date from 2015 to 2013.
4) Give HHS more authority to implement a pilot program that would bundle Medicare payments to hospitals and physicians and allow them to implement the program more broadly without needing additional Congressional approval.
5) Evaluate previously launched health-care pilot programs, eliminate those deemed ineffective, and expand the implementation of those that have proven to be effective.
While none of the provisions would be considered radical changes to the bill, there are a couple of things that are worth noting, both in terms of the politics and the substance. Most significantly, the amendment would not only improve accountability on the part of hospitals and doctors, they would also empower the government in being able to incentive the changes they want and penalize undesirable behavior. Compared to the Republicans’ relentless rhetoric about a “government takeover” of health care, it’s a strikingly different message.
Moreover, while it’s unclear exactly how much money these measures would actually save--Collins noted earlier that CBO was currently scoring the measure--there’s some sign they could be helpful. For example, as Karen Tumulty pointed out yesterday, one of the reasons that cost-control could fail is because many robust ideas have been shuttled to the side in the form of pilot programs that have never been fully implemented; the amendment could potentially expedite the process.
All of this suggests that the Democratic leadership is likely to welcome the provisions and, especially, Lieberman and Collins’ rising desire to cooperate. All three Senators, for instance, indicated that they would oppose Ben Nelson’s Stupak-like amendment to restrict abortion coverage, confirming reports that he’s unlikely to have enough votes for its passage. “Senator Reid has handled the question quite well in the merged bill, and I hope it stays that way,“ Lieberman said, echoed by Collins statement that the current bill “makes it very clear that federal funds cannot be used for abortion.”
That being said, both Collins and Lieberman underscored that their cooperation was also contingent on the removal of the public option. “It doesn’t do anything good,“ Lieberman said. He emphasized that none of the compromises--including Carper’s new proposal to have an opt-in national plan run as a non-profit--appealed to him, hypothesizing that a potential failure of the plan would be akin to the expense of propping up Fannie Mae and Freddie Mac. “Senator Lieberman said it very well,” Collins remarked, adding that Carper’s personal appeals to her also haven’t changed her opinion. Moreover, both are sure to demand other changes to the bill that will raise the hackles of liberal Democrats, as I'll explain shortly.
But there’s no doubt the proposition that Lieberman and Collins put forward today has been the strongest sign yet that they could be willing to get on board with the bill. Sure, the Democrat they invited to support their amendment was none other than a former Republican. But Specter, at least, played the part of a party-line Democrat. Stumping unabashedly for a robust public plan, Specter said he “advised Senator Lieberman and Collins to re-read the fine print” and dismissed their concerns about the plan. He insisted, finally, that his colleagues would also be willing to swing toward the Democratic consensus. The bill “looks so good to Senator Lieberman that he may be willing to make some accommodations,” Specter suggested, prompting some knowing chuckles from the crowd. “And that’s not a laugh line."