Grassley's Attack on Reform Belies Some Earlier Stands

(MoneyWatch)  Just as the Senate's reform legislation was about to be unveiled, Sen. Charles Grassley (R-Iowa), one of the chamber's leading experts on healthcare, published a piece in the New England Journal of Medicine about why the bill would be disastrous if it passed. The piece adds little to the litany of Republican complaints about the Democrats' approach, but it does contain more specifics than any of Grassley's colleagues have been able to muster up to now.

Unlike most other Republicans, Grassley tried to influence the content of the legislation by participating in the discussions of the Senate Finance Committee. In fact, some of the cost-control aspects of the committee's bill, which forms the backbone of the Senate measure, bear the mark of Grassley's efforts. The Senator is quite right when he says in his NEJM essay that neither the Senate nor the House bills take a serious whack at healthcare spending growth. Yet he fails to mention that the Finance Committee bill-which he ultimately opposed-includes measures he favored, such as a value-based purchasing program for Medicare and further limits on Medicare payments to hospitals for treating hospital-acquired conditions.

Grassley lashes out in NEJM at the provision in the Senate Finance Committee bill to create a new Medicare panel of experts, based on the current Medicare Payment Advisory Commission (MedPAC). The new commission would recommend changes in Medicare reimbursement that could only be overturned by an up-or-down vote in Congress, which is usually incapable of saying no to any healthcare interest group. In the past, Grassley has agreed with some MedPAC recommendations, such as the need to reduce the growth of Medicare spending on imaging tests. Yet in his article, he says, "The damage that this group of unelected people could do to Medicare is unknown, although the top actuary at the Department of Health and Human Services recently concluded that cuts of this magnitude will limit benefits and decrease access to care for Medicare beneficiaries."

Grassley criticizes the Democratic reform proposals on a number of other grounds. He claims they will cost nearly $2 trillion "when fully implemented," although he doesn't provide any evidence for that assertion. He says that a public plan will eventually drive private insurers out of business-again, without evidence. (While it is possible that a Medicare-like plan funded by the government could do that, the current public option proposals are very limited and unlikely to survive the legislative fight.) He complains about the expansion of Medicaid, although it's hard to see how the majority of uninsured could be covered without it. And he assails the "taxes and fees that will be pushed onto the consumer." Of course, most of those are related to the requirement that everyone buy insurance-another prerequisite for any serious coverage expansion. And the new tax on "Cadillac" plans in the Senate bill will help restrain health costs, most economists say.

A group of 23 leading health economists recently sent a letter to President Obama that provides a good contrast to Grassley's article. In their letter, the economists said that reform legislation must include four elements if it is to have any chance of controlling healthcare inflation: deficit neutrality, an excise tax on high-cost insurance plans, an independent Medicare commission, and delivery-system reforms. The Senate bill includes all four--if you count demonstration projects as delivery-system reform. Consequently, the measure offers a good starting point for debate. If Sen. Grassley and his fellow Republicans truly care about controlling the healthcare costs that threaten the nation, I hope they will engage forthrightly in that discussion.