Medicare reform: the devil in the detail

A Bloomberg piece today has Commerce Committee chairman-to-be Dingell highlighting an ambiguity in the Dem proposals on Medicare reform.

The party's commitment, as stated on page 6 of the long version of New Direction, was stated (in characterstically dismal fashion) thus:

Fix the medicare prescription drug benefit by putting seniors first by negotiating lower drug prices...

The reference in the 100 Hours list is substantially identical.

Now, of course the pledge can't be read literally. Congress (not even a Dem-controlled one) can negotiate Medicare drug prices.

(And there's the minor matter of getting past GOP filibuster and veto. But let's put that to one side too.)

If the pledge is to make any sense, it needs to be interpreted as one to pass legislation for the executive branch to negotiate prices.

Dingell has pointed up the crucial ambiguity in the pledge:

Representative John Dingell said that he will move to force the Bush administration to negotiate Medicare drug prices when he takes over in January as chairman of the Energy and Commerce Committee.

Such a move, which may curb profits for drugmakers, would go beyond earlier efforts by Senate Democrats to allow the government to negotiate lower drug prices. Health and Human Services Secretary Michael Leavitt said last month that he would resist efforts by congressional Democrats to force him to negotiate volume discounts for drugs.

Dingell, 80, a Michigan Democrat, said the secretary must be required to negotiate, "not just permitted, because we have reason to think that if he's just permitted, nothing will happen.''


Now, you can't help feeling he has a point there!

Merely authorizing negotiations would make the process wholly dependent on the inclination of the prez in office.

(Now, of course, given that the current prez can veto, and almost certainly have the veto sustained, on any bill of the sort from the 110th, his inclination can cut the thing off at source.

So Dingell is clearly making a point of principle: laying the ground for a bill in the a Dem-trifecta 111th that would hopefully be effective in binding later regimes - repealing the law would probably be as difficult as enacting it.)

In contrast to the Dingell view, we have Maj Whip-to-be Durbin:

We're for Medicare being able to negotiate with the pharmaceutical companies in order to save money for seniors.

Which is pretty unambiguously a call for permissive rather than mandatory legislation.

Now, policy discussion amongst Dem MCs can't be a bad thing.

But one just wonders whether this is an issue on which dissent within the party emerged during the campaign, and was fudged in documents like New Direction.

The joys of being in the majority!



Display:


Re: Medicare reform: the devil in the detail (none / 0)

On the Medicare Bill...it's not really that complex.  Republican bill prevented Medicare from negotiating lower prices and Democrats promised to change that.

Easy to do and easy to claim it got done.


by BrionLutz on Thu Dec 07, 2006 at 02:56:38 PM EST

Pretty sharp, though! (none / 0)

Your point is fair but narrow:

Bear in mind that nothing will change in practice in the 110th, because of veto/filibuster of any Medicare negotiation bill, whether permissive or mandatory.

Its value is as a promise of legislation in the 111th if the cards secure a trifecta and a cloture-worthy majority in the Senate.

If the legislation enacted in the 111th is permissive, it would  enable that Dem admin to negotiate; but, if a GOP is elected prez in 12, would allow him to not negotiate.

If the legislation in the 111th is mandatory, that GOP prez would be forced to negotiate, until he got the 110th legislation repealed.

So, you've got a difference PR-wise for the 110th bill - a strong bill makes for a clearer difference with the other side - and a real difference, if it sets the precedent for a mandatory bill to be enacted in a trifecta 111th.

Now, if the Dems were to try to gain credit for a 110th bill that fails to pass the Senate, or has a veto sustained when that bill is a milk-and-water affair, and fails to point out this flaw to the Great American Public - I'd call that pretty cruddy.

But then, we are talking politics!


by skeptic06 on Thu Dec 07, 2006 at 03:10:59 PM EST
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Re: Pretty sharp, though! (none / 0)

Well...yes it is narrow focus but it is a task to get done on the Democrats Promise list and an easy task to get done and check off.

Other Medicare reforms and financing are more difficult but they have to be taken on a case by case basis.

As far as Bush Jr vetoing a bill that allowed Medicare to negotiate lower prices...make my day...that would be a real speed bump for Republican candidates in 2008.

Be interesting to see if McCain (likley Repub. 2008 nominee) would say he'd sign it or not...be a great issue if he said he would not sign.


by BrionLutz on Thu Dec 07, 2006 at 03:26:16 PM EST
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Re: Pretty sharp, though! (none / 0)

The speed bump would be for those who didn't vote to override a putative veto.

I suspect there would be Dem unanimity with only (R) and CfL folks unwilling to risk their pharma contributions.

It would sure be fun to see, though I agree with skeptic that we really need to be sure it's a decent bill. If it actually gets enacted, we want to be comfortable it does what we want it to.


Karl in Drexel Hill, PA
by KB on Thu Dec 07, 2006 at 04:35:54 PM EST
[ Parent ]

For the GOP, the trick... (none / 0)

...is to stymie the bill without needing a veto.

Difficult in the House, but possible in the Senate: scheduling the bill would need a unanimous consent agreement which would have to allow for floor amendments from the minority.

The GOP should have crafted several amendments, germane and plausible, but utterly unacceptable to the Dem leadership.

When one of those is offered, the natural response of the floor manager would be to offer a motion to table; but if the amendment has majority support, that would probably mean defeat of the MTT, and some embarrassment for the majority.

Better get the GOP amendment taken out of the bill during conference.

But, if the amendment has genuine bipartisan support in the Senate, it's just possible that Senate conferees may object to removing the amendment.

Then, of course, there's the filibuster: this needs to have some motivation that can be sold in the media; the GOP stance would be to blame the Dems for doctrinaire intransigeance and partisan rancour - all the usual bollocks - with the filibuster being resorted to more in sorrow than in anger.

My guess - there will be a bill passed and Bush won't veto it. But only because, by the time it emerges from Congress, it's the equivalent of the 1957 Civil Rights Bill - a civil rights bill with precious little civil rights in it.


by skeptic06 on Thu Dec 07, 2006 at 06:05:24 PM EST
[ Parent ]


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