A recent article in the Wall Street Journal (reproduced here) explained how a little known and innocuous sounding agency called the Center for Medicare and Medicaid Innovation may be the most troubling part of Obamacare.
The Center for Medicare and Medicaid Innovation has flown below the political radar. That’s due to its seemingly innocuous mission: promoting new and more efficient “payment systems” and “models of care.” But this agency is just as dangerous as IPAB. It is a bureaucracy within the massive Department of Health and Human Services superstructure and therefore run by the president’s political appointees. But unlike most of the federal bureaucracy, the agency never has to go back to Congress to get an appropriation. Obamacare provided it with $10 billion, upfront, to cover its costs for a full 10 years.
At the end of that first decade, and every decade thereafter, the agency will get another $10 billion appropriation. This massive infusion of funding has allowed the Center for Medicare and Medicaid Innovation to grow from 68 employees in 2012 to a planned 440 full-time workers in 2015. About 10 percent of the agency’s funding is going to personnel and administrative expenses.
…The statute also gives the Center wide-ranging authority to alter the Medicare and Medicaid programs without further congressional action. It is supposed to be testing new ways to pay providers of medical services. Changes that are found through pilot programs to reduce costs without harming quality, or found to be budget neutral while improving quality, can be implemented nationwide through regulatory fiat.
The agency’s broad mandate reveals the mind-set of Obamacare’s authors. The premise is that the federal government is best positioned to lead an effort in innovation in medical delivery, despite all evidence to the contrary. The history of Medicare’s payment systems over four decades is one of politicized decision-making by regulators, protection of incumbent providers, and roadblocks to new medical technologies and new ways of doing business, such as using information technology to consult with patients, or employing non-physician clinics for routine patient care. It’s the opposite of an environment conducive to innovation. Consequently, inefficiency is rampant in Medicare’s traditional fee-for-service program.
It’s not hard to imagine this agency, insulated from oversight and political accountability, going completely off the rails. It’s exactly the sort of power that tends to be hijacked by radicals to impose their authoritarian vision.
