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LINDA WERTHEIMER, host:

It's MORNING EDITION from NPR News. I'm Linda Wertheimer.

STEVE INSKEEP, host:

And I'm Steve Inskeep. Good morning. Here's one of the biggest sticking points in the health care debate: how to bring down the high cost of medical care. President Obama's administration hopes that part of the answer is an independent panel of experts. That panel would have the power to force Congress to vote each year on spending for the Medicare program. But as NPR's Julie Rovner reports it seems that every change to the health package that pleases one constituency angers a different one.

JULIE ROVNER: There already is a panel of doctors and other health experts that makes recommendations about the operations of the vast Medicare program: the Medicare Payment Advisory Commission, or MedPAC. Every year, MedPAC sends Congress two reports, one on how to make Medicare run better.

Mr. ROBERT REISCHAUER (Economist): And the other volume provides recommendations for annual increases in payment levels for each provider type.

ROVNER: Economist Robert Reischauer was a long time member of MedPAC. He says annual inflation increases for doctors, hospitals and other health care providers are built into the law. But sometimes inflation or market conditions make those increases inappropriate.

Mr. REISCHAUER: And what MedPAC does is present Congress with an alternative set of recommendations, which the Congress can review and act on.

ROVNER: Can is the operative word in that sentence. Congress often ignores MedPAC's recommendations, particularly when they call for cuts in payment to any of those providers. One of the first lawmakers to propose giving MedPAC real power was West Virginian Democratic Senator Jay Rockefeller. He called it MedPAC on steroids. He says members of Congress basically need to be protected from themselves.

Senator JAY ROCKEFELLER (Democrat, West Virginia): I've been working on health care for 25 years in the Senate, and I have very rarely seen senators doing things which are against the interests of particular durable medical equipment, or oxygen or whatever, in their states. Each of those has a lobbyist attached to it. Each of those lobbyists is making six or seven-figure salaries for the sole purpose of getting more, more, more, more.

ROVNER: Which tends to run up health care costs. Earlier this month, the Obama administration offered a variation on Senator Rockefeller's proposal. It would set up a new panel called the Independent Medicare Advisory Council, or IMAC. Every year, the council would come up with a set of payment recommendations for health care providers which the president and Congress could approve or reject, but not amend.

President BARACK OBAMA: What we want to do is force Congress to make sure that they are acting on these recommendations to bend the cost curve each and every year.

ROVNER: So far, the fiscal conservative Blue Dog Democrats in the House have embraced the idea of a commission that would force votes on Medicare cost cutting. But there are more than a few obstacles in the way. One is the fact that bringing the Blue Dogs into the tent may be driving others out. Doctors and hospitals who've endorsed the House bill are very uncomfortable with the independent-commission-with-power idea. Rick Pollack is executive vice president of the American Hospital Association. [POST-BROADCAST CORRECTION: The AHA has not endorsed the House bill.]

Mr. RICK POLLACK (Executive Vice President, American Hospital Association): It would have real problems for us.

ROVNER: Pollack says hospitals have already agreed to see their Medicare payments cut by $155 billion over the next 10 years to help pay for a health overhaul.

Mr. POLLACK: And what we're concerned is that this IMAC notion that is really being considered on the House side as part of the effort to bring the Blue Dogs on board is something that would jeopardize, you know, that number.

ROVNER: There's still another problem, says former MedPAC member Bob Reischauer. Today, the commission manages to be an honest broker largely because it doesn't wield much power.

Mr. REISCHAUER: If it were given real bullets, the individuals who would make it onto MedPAC would be a very different class of people, and they would take their jobs much more as representing the hospitals, representing the physicians, representing the home health agencies. And they would fight tooth and nail against cuts that they perceive to be too deep.

ROVNER: That's one of the main reasons the Congressional Budget Office said the administration's proposal probably wouldn't save much money. But the CBO also said that with some key changes, an independent commission could save a lot of money over the long term.

Julie Rovner, NPR News, Washington.

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