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Many skeptical on health cost-cutting

Some Democrats say plans don’t check spending

'Let's be honest,' White House chief of staff Rahm Emanuel said. 'The goal isn't to see whether I can pass this through the executive board of the Brookings Institution. I'm passing it through the United States Congress with people who represent constituents.' "Let's be honest," White House chief of staff Rahm Emanuel said. "The goal isn't to see whether I can pass this through the executive board of the Brookings Institution. I'm passing it through the United States Congress with people who represent constituents." (Olivier Douliery )
By Sheryl Gay Stolberg
New York Times / November 10, 2009

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WASHINGTON - As health care legislation moves toward a crucial airing in the Senate, the White House is facing a growing revolt from some Democrats and analysts who say the bills Congress is considering do not fulfill President Obama’s promise to slow the runaway rise in health care spending.

Obama has made cost containment a centerpiece of his health care agenda, and in May he stood up at the White House with industry groups who pledged voluntary efforts to trim the growth of health care spending by 1.5 percent, or $2 trillion, over the next decade. But the bills, including one passed Saturday night by the House, may not meet that goal, analysts say.

Analysts - including some who have consulted closely with the White House, like Dr. Denis A. Cortese, chief executive of the Mayo Clinic - say the measures take only baby steps toward revamping the current fee-for-service system, which drives up costs by paying health providers for each visit or procedure performed.

Senator Ron Wyden, an Oregon Democrat and member of the Finance Committee who has worked on health policy, also sounded skeptical. “My assessment at this point,’’ Wyden said, “is that the legislation is heavy on health and light on reform.’’

There are a variety of ideas for attacking cost increases more aggressively, including setting Medicare reimbursement rates for doctors and hospitals more rigorously and discouraging workers and employers from buying expensive health insurance policies that mask the true costs of treatment.

Health economists are increasingly advocating a cost-cutting method known as “bundling,’’ in which health providers receive a lump sum to care for a patient with a particular medical condition, say, diabetes or heart disease. The House bill calls for the administration to develop a plan for bundling, while the Senate Finance Committee version of the bill gives it until 2013 to create a pilot program.

Senators of both parties say they will press for more aggressive cost-cutting measures when the bill comes up for debate. But drastic changes in the health care reimbursement system could cost the White House the support of doctors and hospital groups, who have signed onto the legislation and are lobbying hard to keep the current fee-for-service system from being phased out too quickly.

The debate underscores a fundamental tension inside the White House between cost-containment idealists and pragmatists.

The first group includes officials like Peter R. Orszag, the budget director, and Dr. Ezekiel J. Emanuel, the medical ethicist whose brother Rahm is the chief of staff.

The second includes Rahm Emanuel and Nancy-Ann DeParle, the director of the Office of Health Reform, who must contend with the realities of getting legislation passed.

“Let’s be honest,’’ Rahm Emanuel said in a recent interview. “The goal isn’t to see whether I can pass this through the executive board of the Brookings Institution. I’m passing it through the United States Congress with people who represent constituents.’’

He went on: “I’m sure there are a lot of people sitting in the shade at the Aspen Institute - my brother being one of them - who will tell you what the ideal plan is. Great, fascinating. You have the art of the possible measured against the ideal.’’

Orszag would not be interviewed.

But in an e-mail message sent through a spokesman, he said the current legislation “lays the foundation’’ for cost-cutting over the long-term, adding: “Will more need to be done in the future? Absolutely.’’

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