Missed Opportunities

If hand-wringing and finger-pointing actually generated dollars, Washington, DC would probably be able to solve the federal deficit problem today.  With ‘super committee’ negotiations collapsing and members of the Joint Select Committee on Deficit Reduction formally admitting that they won’t have recommendations to submit by the November 23 deadline, the Beltway blame game is in full swing.  Kaiser Health News has a good summary of the news coverage taking place today – with links.

Worries about whether there will be meaningful spending cuts are premature.  The November 23 date was an artificial deadline anyway.  With the automatic sequestration cuts not taking place until 2013, Congress has an entire year to figure out $1.2 trillion in savings alternatives.

That’s not to say there aren’t serious missed opportunities in the ‘super committee’s’ failure to act.  With the nation’s focus on their deliberations, this was an ideal time to launch a national debate on how to reform Medicare, make the program more cost-efficient and more sustainable for the long run.  That public debate didn’t happen.

Sure, there were some ideas on the table for reforming entitlement programs.  Some, like raising the Medicare eligibility age, warrant serious discussion.   There were also reportedly discussions, though, focused on the tired, old approach of cutting payments to Medicare providers (and pretending this doesn’t affect beneficiaries’ access to quality care and medical innovations.)

What was lacking was a serious conversation about the issue raised by former Clinton budget director Alice Rivlin and former U.S. Senator Pete Domenici in their testimony to the Select Committee.  Structural changes to the Medicare program, which the two experts said is essential in order to address the nation’s debt crisis, didn’t get off the launching pad.

It seems strange to me that there would be such political intransigence in some quarters to the concept of reforming Medicare to give beneficiaries a greater degree of choice in their health coverage.  It’s a structure that has worked well with the Federal Employees Health Benefits Program and the Medicare Part D prescription drug benefit, and it’s going to be utilized in the Affordable Care Act’s state health insurance exchanges.

Yet, when it comes to Medicare, there is a greater willingness by some to simply cut dollars from the program, thus undermining both quality and access, than to create a role for the private sector in driving value and cost-efficiency.

The ‘super committee’s’ failure to take up the cause of Medicare reform was a missed opportunity.  It will come back around again, though.  As Dr. Rivlin and Senator Domenici accurately point out, you can’t fix America’s debt problem without it.