The last thing President Obama needs is more opposition on health care. Especially from his own party, let alone from its liberal wing. But that is the latest twist in his political travails.
Several Democratic members of Congress plan to challenge the foundation of his Medicare cost-control plan. That foundation is the Independent Payment Advisory Board (IPAB) created under the health reform law. Obama’s plan would empower it to impose cuts if spending rises faster than a target rate and Congress fails to act.
A prominent Philadelphia Democrat is helping to lead the charge. Rep. Allyson Y. Schwartz (D., Pa.) has co-sponsored a bill to repeal IPAB entirely.
The new opposition comes at a sensitive time. Obama released his Medicare plan last week to counter a Republican proposal that would move all seniors into private insurance coverage. He is just starting to build momentum for his alternative.
Why is Obama getting heat from his left? His opponents voice concern that his plan is undemocratic. Congresswoman Schwartz fears the power Obama would give to a set of unelected experts. She foresees a lack of transparency and a loss of responsiveness to the needs of seniors.
Another Democratic opponent of IPAB, Rep. Shelley Berkley (D., Nev.), has concerns that are more political. She is comfortable having fellow Democrat Obama appoint the initial board members. But she has less faith in future presidents to choose board replacement wisely.
Of course, philosophy is only part of the story. IPAB opponents are also concerned that it would slash payments to hospitals and physicians. These can be important constituents.
Some prominent conservative Republicans share these misgivings. Among them is Rep. Paul Ryan (R., Wis.), architect of the competing plan. He is joined by Sen. John Cornyn (R., Texas), who fears an “unelected, unaccountable board of bureaucrats.”
Why does Obama want to take the power to reshape Medicare away from elected officials? It is because he fears they would never have the political will to make hard choices. For many members of Congress, voting to cut a popular program could be political suicide.
The dilemma is similar to the challenge of closing unneeded military bases in the 1990s. Most members of Congress agreed that cuts were needed, but none could publicly accept a closure in their district. The solution then was an independent commission empowered to select which bases to close. IPAB would play a similar role.
Obama’s opponents do have legitimate concerns about removing key decision-makers from political accountability. But poking holes in a proposal is easy. Crafting an alternative is much harder. Long experience teaches how difficult it is for elected bodies to ask constituents for sacrifices, whether in the form of benefit cuts or tax hikes.
The Ryan plan would pass the cost-cutting buck to private insurance companies that have no political accountability. The cuts they impose could be draconian. Medicare could be reduced to a shell of its present self.
If Obama’s Democratic opponents want to counter that approach, they have to offer more than criticisms. Existing proposals may have flaws, but Medicare costs won’t come down on their own. A reasonable recommendation from the left could do a lot to advance the case that spending growth can be tamed without leaving the program gutted.
Let the political heavy lifting begin.
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