The Dull Reality of Change

The so-called "pep talk" the president gave a few minutes ago could have benefited from a bit more pep. Barack Obama seemed tired, almost somber. The early word was that he would use the unscheduled address to reignite excitement over health-care reform. Instead, he gave a detailed explanation of where we are in the health-care reform process. The emphasis wasn't on excitement or persuasion, but reassurance. This prompted an incensed, semi-coherent tweet from Sen. Chuck Grassley, who specializes in such things:

Obama speech on healthCareReform Absolutely nothing new Waste of time saying we are going to get that done Baucus and I know that But doRITE

So writes the guy who's supposed to be writing heath-care reform. Confidence-inspiring, innit? But this question of, as Grassley so eloquently put it, "doRITE," is an interesting one. Insofar as there was anything new in Obama's speech, it was his full-throated advocacy of the Independent Medicare Advisory Council (IMAC) (formerly known as MedPAC). This really is a good idea. But it's an idea that probably makes Grassley mad.

The theory underlying IMAC is that Congress cannot do health-care reform, err, RITE. It is too captured by special interests and too baffled by technical arguments and too paralyzed by partisanship. Leaving the continual tweaks and hard decisions that will bend the curve over the long term up to Congress is a bit like asking JD Salinger to blog: It might happen occasionally, but it's not a safe bet. The IMAC proposal substantially removes Congress from the process. The letter that Peter Orszag sent to Nancy Pelosi explained how it would work:

This draft bill would establish an Independent Medicare Advisory Council (IMAC), which would have the authority to make recommendations to the President on annual Medicare payment rates as well as other reforms. Both the annual payment updates and the broader reforms would be prohibited from increasing the aggregate level of net Medicare expenditures. This proposed legislation would require the President to approve or disapprove each set of the IMAC’s recommendations as a package. If the President accepts the IMAC’s recommendations, Congress would then have 30 days to intervene with a joint resolution before the Secretary of Health and Human Services is authorized to implement them.

In a way, this seems small. But it's what cost control looks like in practice. It's Congress recognizing that it's a process, and a process for which it is ill-suited. It's an expert body able to continuously evaluate the data and make changes to Medicare that will increase the program's effectiveness and decrease its costs. There has been a theory, for many years now, that the health-care system's cost problems would eventually be solved all at once when some popular president and some large congressional majority finally got serious about the issue and made the big, hard decisions.

Well, that's happened, and what we're seeing is that they can barely pull off the easy stuff, much less the hard stuff. There will be no big, wrenching concessions. We will not have an exciting, thrilling, satisfying conclusion to our health-care woes. Not for the foreseeable future, anyway. Instead, we'll begin doing things a bit differently. Making things a bit better with each year rather than a bit worse. Putting a process like IMAC into motion is one way to do that.

Photo credit: AP Photo/Jae C. Hong>