STEVE INSKEEP, host:

In this climate, one priority for both parties is reducing the cost of programs like Medicare. Yet this week, Republicans are launching an effort to eliminate the one part of last year's health overhaul that would slow Medicare spending.

Some Democrats also have doubts, as NPR's Julie Rovner reports.

JULIE ROVNER: Just how much do Republicans dislike the new Independent Payment Advisory Board? Here's Republican Senator John Barrasso of Wyoming.

Senator JOHN BARRASSO (Republican, Wyoming): I believe it is a rationing board that is going to ration care for our seniors.

ROVNER: And here's Republican Congresswoman Diane Black of Tennessee.

Representative DIANE BLACK (Republican, Tennessee): A board that is appointed, people that are going to make decisions about what kind of care is going to be given to the patients will destroy the very core of what has made our medical system the best in the world.

ROVNER: What the law actually calls for is a board of 15 health experts to be appointed by the president and confirmed by the Senate. Their task is to make recommendations for ways to reduce Medicare payments without cutting benefits or increasing costs to Medicare beneficiaries. Now, that's not much different from an existing panel of expert Medicare advisors, except for one thing: Congress is free to ignore that board's recommendations. And it does, routinely.

That won't be the case with the new payment advisory board. Its recommendations will take effect unless both houses of Congress override them with a two-thirds vote.

Georgia Republican Congressman Phil Gingery is one of many who finds that excessive.

Representative PHIL GINGERY (Republican, Georgia): Even if the Congress could muster up both the House and the Senate a two-thirds vote - which is virtually impossible - but in the remote possibility that we could, we would have to find cuts somewhere else other than what they recommended in the Medicare program.

ROVNER: Meaning Congress would have to replace the recommended cuts it's disapproving with other Medicare cuts. But backers of the new board say it's likely to do a better job deciding how to pay doctors, hospitals and other medical providers than Congress itself does.

West Virginia Democratic Senator Jay Rockefeller, who's one of the board's biggest backers, says now the biggest winners are inevitably those with the most effective lobbyists.

Senator JAY ROCKEFELLER (Democrat, West Virginia): The Congress often does know how to say no, and the Congress has a practice of never saying no. And so costs go up.

ROVNER: Rather, says Rockefeller, it would be better not only to insulate Congress from all those lobbyists, but to get people with more expertise on deciding how medical providers should be paid.

Sen. ROCKEFELLER: You want to have the Gail Wilenskys and the Bruce Vladecks, etc., people have broad health care policy experience making those decisions.

ROVNER: There's just one problem. Both Gail Wilensky and Bruce Vladeck - each of whom ran the Medicare program under previous administrations - think the independent payment board is a bad idea. Wilensky, who oversaw Medicare for the first President Bush, says she worries that the board is limited to looking only at payments to health providers.

Ms. GAIL WILENSKY (Health Care Economist): Since the IPAB is not allowed to consider any other changes, such as eligibility or the benefits, or anything else but provider reimbursements.

ROVNER: That's supposed to prevent it from being able to ration care. But Wilensky and others worry that it could end up driving Medicare payments so low that providers will simply leave the program, or else go bankrupt if they can't.

Former Medicare head Bruce Vladeck, who ran the program under President Clinton, has a different problem with the board. He worries that eventually, the lobbyists who are now so influential with members of Congress will become equally influential with the unelected members of the board.

Dr. BRUCE VLADECK (Former Head of Medicare): In the short-term, it might theoretically work again, our history with the ICC...

ROVNER: That's the Interstate Commerce Commission.

Dr. VLADECK: ...or the Civil Aeronautics Board, or lots of other independent regulatory agencies, is by the second generation, they tend to do more to protect the regulated industries than they do to protect consumers.

ROVNER: But not every outside expert thinks the board is a bad idea. Princeton health economist Uwe Reinhardt says Germany has a similar independent group that writes all that nation's health care regulations.

Mr. UWE REINHARDT (Princeton University): And so go to Germany, study it, and you will find that this really works. It's civilized.

ROVNER: But two days of hearings that began today will likely show that those from both parties doubt such a board will work here in the U.S.

Julie Rovner, NPR News, Washington.

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