Special interest groups and congressional Republicans are exhibiting little enthusiasm for an appointed commission to examine Medicare's long-term solvency.
Before the election, HHS Secretary Donna Shalala gave a glimpse into Clinton's second term. Those plans included reducing projected provider reimbursements by $100 billion over six years and the appointment of a blue-ribbon commission to address long-term changes to Medicare that would be similar to a 1983 bipartisan commission on Social Security.
GOP presidential candidate Bob Dole also supported the idea of a commission. But many Republicans believe they lost several House seats because of Democratic attacks over Medicare, and they aren't willing to give Clinton an easy road on Medicare reform.
In a recent speech, Rep. William Thomas (R-Calif.), chairman of the House Ways and Means health subcommittee, attacked the commission idea (See story, p. 48).
"Saying you are going to create a commission does not solve the problem," Thomas said. Thomas warned that Republicans would not support a plan that would "take all the easy (changes) and . . . . then try to push all the difficult stuff off to a commission. I am very leery about a future Congress accepting nothing but pain and grief from a commission.
"There is nothing that could be proposed by a commission that hasn't been proposed" already, Thomas added.
Special interest groups seemed resigned to the idea of a commission but had little enthusiasm for it.
"We're not wild about a commission," said Neil Trautwein, manager of healthcare policy for the U.S. Chamber of Commerce. "We think the model passed by Congress last year is the best model for the future of Medicare and there is no reason to delay by appointing a commission."
Jim Stacey, spokesman for the American Medical Association, said that reforming Medicare "will require some tough decisions, and if structured right, a commission could be all right. But we already know what has to be done. Political decisions have to be made, and we need to get on with it right away," Stacey added.
Even the Clinton administration seemed to be reconsidering the idea of a commission. White House spokesman Mike McCurry said last week that "the president will continue to work the idea," after GOP leaders questioned the plan during a meeting with Clinton.
There also is some disagreement about how a commission should be structured.
Thomas said that any commission not structured like the military base closure commission would be useless. The base closure commission recommended mothballing a number of military bases. In order to stop powerful lawmakers from saving bases in their districts, Congress was only able to vote yes or no on the list as a whole. "Unless you require a straight up or down vote no matter what the product is, why waste your time?" Thomas said.
But Thomas Scully, president of the Federation of American Health Systems, said a "base closure (commission) structure with a clear up or down vote is very dangerous. You can't be sure that what they come up with is good policy. You have to have some process to ensure that their recommendations are reviewed."