Deficit Commission

The key point in the Deficit Commission's Chairmen's Proposal[1]:

Set global target for total federal health expenditures after 2020 (Medicare, Medicaid, CHIP, exchange subsidies, employer health exclusion), and review costs every 2 years. Keep growth to GDP+1%.

 Well hell, if the CBO could just say keep health care inflation to GDP+1%, then we wouldn't need a Deficit Commission in the first place. And their mechanisms for achieving this?

If costs have grown faster than targets (on average of previous 5 years), require President to submit and Congress to consider reforms to lower spending, such as:

• Increase premiums (or further increase cost-sharing)
• Overhaul the fee-for-service system 
• Develop a premium support system for Medicare
•  Add a robust public option and/or all-payer system in the exchange
•  Further expand authority of IPAB

Now that's all well and good. I recognize that each of these could in fact lower the health care inflation rate. And I certainly like the "Add a robust public option and/or all-payer system in the exchange," although I suspect that when crunch time came we would have a premium increase, a premium support system for Medicare, and maybe, just maybe, an expansion of the authority of the IPAB.

The main problem is political: "require President to submit and Congress to consider reforms to lower spending." Now there might be some mechanisms that could require Congress and President to do this, but I can't think of any off the top of my head that would not be easily avoided by a Congress or President who didn't want to take on health care. The exception, of course, is that if health care costs continue to rise at the rate they've been rising, then eventually there will be so much pressure to tackle the deficit (interest rates will be high and the Fed will say that interest rates are where they need to be to maintain price stability) that some course of action, almost certainly involving caps, rationing, and withdrawal of coverage, will be necessary.

But avoiding this seems to be the whole point of a Deficit Commission. So "mandating" these changes doesn't really make much sense to me, if the only real mechanism for making the President and Congress act is the fact that the problems of a large debt have already arrived.

[1] Note the qualifiers--this is not the Deficit Commission's proposal, as they are unlikely have the 14 votes needed to approve the report. Rather, this is the Chairmen's proposal, sent out to the media in order to dominate the conversation. Its release was not approved by the full commission, many of whose members are surprised that the chairmen did this, considering they have yet to vote on these proposals. Furthermore, the Deficit Commission is not a congressionally established Commission--it has no privileged procedural rules, as was originally proposed, and so its primary influence is in shaping the conversation. Which is partly why having staffers whose salaries for working on the commission are paid for by hard-right conservative institutes and centrist New Democrat institutes is such a scandal. Kevin Drum puts it well:

It's just a draft presentation put together by two guys. Do you know how many deficit reduction proposals are out there that have the backing of two guys? Thousands. Another one just doesn't matter.

I disagree on the "just doesn't matter point," largely because I think the Chairmen knew damn well that the headlines were going to be  "Examining The Deficit Commission's Proposals" (NPR) and "Examining The Deficit Commission's Proposals" (Examiner.com) and "Factbox: Deficit commission tax cut ideas" (Reuters) and "The President's Deficit Commission Makes Recommendations" (Nightly Business Report) rather than "Two Guys Spew Off."