Reflex: December 20, 2011

House will not have direct vote on Senate deal, writes Tom Cohen and Alvin Silverleib. The two month extension of the payroll tax cut, Unemployment Insurance and the doc fix that passed the Senate 89-10 on Saturday appears dead in the House and there will not be a direct vote on the Senate measure; Senate Democrats say they will not negotiate a full year extension of the payroll tax cut (that everyone wants) until the House passes the 2 month version. Don’s comment: This is not as dumb and dysfunctional as the debt ceiling debacle in August, but there is still time.

Ezekiel Emanuel rejects premium support. “Premium support is classic cost shifting, rather than cost cutting. […] To address the root of the cost problem, we must change how we pay doctors and hospitals. We must move away from fee-for-service payments to bundled payments that include all the costs of caring for a patient, thereby encouraging providers to keep patients healthy and avoid unnecessary services.” Austin’s comment: Premium support is a broader concept than Emanuel suggests. It need not shift costs to Medicare beneficiaries. However, Emanuel’s conclusion is reasonable. The type of cost cutting we need will not be found in premium support alone. My recent series covered all these points and more.

The administration’s first crack at essential benefits guidance is drawing no backlash, says Jason Millman. “The Obama administration’s first crack at defining minimum health benefits did exactly what consumer groups hoped it wouldn’t do: It gave states a choice of “benchmark” plans rather than spelling out the details. But the administration seems to have pulled it off — because there was no backlash to be found from groups that championed the law.” Aaron’s Comment: (1) It provoked no backlash because it punted the call to the states. (2) It’s sad that “success” is now being defined as not angering anyone. (3) That just doesn’t seem worthy


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