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Why hasn't Obama appointed a Medicare/Medicaid adminstrator?


President Obama has made health care his top priority. He says the cost of Medicare and Medicaid is “the biggest threat” to the nation’s fiscal future. But to the puzzlement of Congress and health care experts around the country, Mr. Obama has not named anyone to lead the agency that runs the two giant programs.

The agency, the Centers for Medicare and Medicaid Services, is the largest buyer of health care in the United States. Its programs are at the heart of efforts to overhaul the health care system. If it had an administrator, that person would be working with Congress on legislation and could be preparing the agency for a new, expanded role.

So, Obama doesn't want a Medicare/Medicaid administrator working with Congress then, right? I wonder why?

“The vacancy stands out like a sore thumb,” said Dr. Denis A. Cortese, president of the Mayo Clinic, often cited by the White House as a health care model.

“In effect,” Dr. Cortese said, “Medicare is the nation’s largest insurance company. The president and Congress function as the board of directors.

“Under a strong administrator, it could take the lead in making major changes in the health care delivery system, so we’d get better outcomes and better service at lower cost.”

So, Obama doesn't want a Medicare/Medicaid administrator taking the lead in making major changes, right? I wonder why?

Trying to remake the health care system without a Medicare administrator is like fighting a war without a general.

Well, that would depend on how you define the war, wouldn't it?

If the war is to make sure that the insurance companies have a guaranteed market, and their power in the system is increased relative to Medicare/Medicaid, then making sure that the Medicare/Medicaid side has no general would make a lot of sense.

We saw this same style of non-decision making once before at Treasury, where Obama's non-appointments meant that policy was essentially outsourced to the banksters, especially Goldman Sachs.

So, I'd guess that Obama hasn't appointed a Medicare/Medicaid administrator because he wants to outsource policy to the health insurance companies (and fuck the Medicare/Medicaid recipients).

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gqmartinez's picture
Submitted by gqmartinez on

If it were just health care *or* the bank bailouts I could see using incompetence as an excuse and getting away with it. Since he whipped behind the scenes, I don't see that as a viable excuse but I can see how some could use it to hide his intentions. But this pattern seems to very strongly suggest that Obama cares more about the financial overlords or that he believes the Reagan shit about voodoo economics. Either way, its not good.

Valley Girl's picture
Submitted by Valley Girl on

What I've read MSM seems to indicate that it's all up to the Senate.

But, since there are certain problems (ahem) on stuff that involves reading of law, say re: torture, I'm thinking that if Obama really wanted to finalize this, he could twist arms.

Sorry this is a bit of a cryptic comment- not quite the same pattern, but maybe smoke and mirrors also?

Submitted by Paul_Lukasiak on

lets face it -- if there was a Medicare admininstrator, that person would be an advocate for his/her agency's bottom line.
In other words, Obama's back room deals with the drug companies don't just break his campaign promises, it ties the hands of Medicare at a point where every dollar of potential savings extends the life of the Medicare Trust Fund. If there was a medicare administrator, that person would be raising holy hell about the PhRMA sell-out.
Obama is using Medicare to "balance" his health care proposals -- and again, this is a crucial consideration for Medicare solvency. While his fancy bookkeeping may just be all smoke and mirrors (i.e I doubt that they can transfer savings out of Medicare that Obama thinks he can achieve with "outcome based" reimbursement schemes in order to pay for subsidies for health insurance for lower income families), the very fact that Obama is willing to try and soak Medicare for the cash he needs to make his reform "revenue neutral" tells us how little he's committed to Medicare itself.

For Obama, Medicare is simply another resource to use to burnish his reputation -- it doesn't matter what happens to the system, as long as he can claim a "victory" on health care "reform"

Submitted by jawbone on

Yes, this makes sense. And if also indicates the seniors on Medicare and those looking forward to being on Medicare should be extremely wary of what Obama wants to do.

He says he'll cut Medicare and Medicaid (the latter chronically underfunded and people can't get on it when they are eligible), but somehow it will only be "fat" and those subsidies to the Big Insurance Parasites (BIP). Of course, the BIP will be fed more victimes via the mandates and some of those will be subsidized...

Out of one pocket, into the other, only bigger subsidies over all.

dblhelix's picture
Submitted by dblhelix on

think alike (see comment below).

indicates the seniors on Medicare and those looking forward to being on Medicare should be extremely wary of what Obama wants to do.

I'm going to be honest about something. I have not found senior fears of "death panels" to be entirely unreasonable.

While "death panels" itself obviously hyperbole, pretty much April-June (when health insurance reform was called health care reform, and Obama's favs were higher) Obama did nothing but moan about his grandmother's hip replacement and should society pay for it?

There was so much about "overutilization" in the usual places, like the NYT, etc, courtesy of that awful Dartmouth study, underwritten by insurance companies, for crying out loud, where "overutilization" appears to have taken place primarily in areas w/ a lot of impoverished seniors. There was also an article in the NYT from a Princeton ethicist calling for rationing of costly life-extending measures directly. It used an extreme example, like they always do, of should we we pay a gazillion dollars for six days of life?

In the UK, the balance between cost and median life extension is a consideration, but they have a much smaller health budget than we do, and the types of people they have on their health boards are beyond reproach (not Wall St, not making a profit, not selling kidneys in NJ).

In other words, as long as the American taxpayer is subsidizing Viagra for tribal chieftains in Afghanistan, I say give granny what she needs. And speaking of the taxpayer, am I the only one who is kind of disgusted that Whole Foods Nation is reassured that they won't pay more in taxes while Medicare gets chopped? So much for sacrifice.

TreeHugger's picture
Submitted by TreeHugger on

former Gov of New Mexico raise the issue of the cost of end of life care some years ago? As I recall he was roundly tut-tutted for it by the Villagers and just about everyone else, but this was probably outshouted by the furor over his proposal to legalize pot.

FWIW, I think it is a topic deserving honest discussion, but the hysteria now prevailing prevents that for the foreseeable future.

I do agree with the overall points made in your post.

Submitted by jawbone on

not "end of life" efforts or expenses.

Just sayin'.

To tired to go into my personal anecdote about the woman in her 70's who was considered at end of life -- until her sister did some digging (pre-internet) and found a doctor who understood the problem. The woman recovered because her sister was not limited in the choice of doctors. She died of old age in her early 90's.

Had she died in her 70's, her statistics would have been added to the "end of life" futile expense.

Submitted by hipparchia on

it's the biggie that the dartmouth atlas project is pushing -- we spend way too much on dying people in some parts of the country, and if we'd just spend less on them, we could cut costs a lot.

well, ok, but when do you stop?

i'm all for letting people refuse extraordinary care at the end if that's what they want, but to save money by telling everyone ahead of time that we spend too much on the very, very sick?

sure, no problem with that, if we were in a sane system that didn't funnel 20 or 30% of it $$ resources into fatcats' pockets. cut out all the shareholders, all the hospital corp ceos, all the drug corp ceos, all the 'healthcare' lobbyists, all the other freeloaders, first, then let's evaluate what we can afford to spend in seemingly hopeless situations.

like jawbone, i got stories about this too.

Submitted by cg.eye on

After the death of Glass-Steagall, there is absolutely no safeguard from financial companies looting insurance premiums for their own ends.

As we've seen with credit cards, once the banksters co-opted state-level regulators (either through defanging them through lobbying state legislator pressure or making them irrelevant, as with the OCC against the state Attorneys General) it's a cinch for them to get away with anything, after decades of Federal government being forcibly shrunk. The people who benefit from TARP actions on the banking and investment arenas are waiting for their windfall, once the insurance system is broken.

The only thing stopping the truly super-rich from letting this country die is their sentimentality over tourist attractions and the swiftness of their capital flight arrangements.

Submitted by lambert on

I wish you'd expand on this in a post with a lot of linky goodness.

It's the analytical base for the mandate === bailout argument.

dblhelix's picture
Submitted by dblhelix on

because he's waiting on the formation of that "independent" executive branch panel to cut Medicare to find "savings"

A strengthened MedPAC is seen by some lawmakers as a means to make policy changes in the Medicare program that would reduce long-term medical costs. While the Congressional Budget Office has said that one version of the proposal would result in only $2 billion in savings over a 10-year period, a larger savings estimate could arise if the new entity is given a target for cutting costs.

It's supposed to work like a trigger that automatically goes into effect to cut costs unless Congress can find cuts costs elsewhere by the same amount.

I mean, we had to find a way to support pharma handouts like making sure that they don't have to deal with Medicare rebates!

I don't understand how any "progressive" can support this "reform."

Submitted by Paul_Lukasiak on

well, if you are an a-lister who dropped the ball on single payer, and bought into the HCAN parasite's pitch, "buying into" the words "public option" is your only shot to prevent your tattered credibility from shredding completely,....

Submitted by jawbone on

bills and WH deals: Most health industry players would win under overhaul

Hospitals treating the poor will come out much better; those treating Medicare patients not so well.

.... Hospital groups agreed to give up $155 billion in Medicare funds over the next decade, or about an 8 percent cut. But the industry believes it will gain $170 billion by having to treat fewer uninsured patients.

"The hospitals did quite well for themselves," said Sheryl Skolnick, a hospital analyst with CRT Capital Group in Stamford, Conn.

But Skolnick and other experts note that health overhaul will affect individual hospitals differently. For instance, hospitals that treat greater numbers of uninsured — generally urban and public hospitals — will gain the most, while those most dependent on Medicare may face the biggest financial risks because of proposed cuts.

So, yeah, those people worried about Medicare may be worried for the wrong reasons, but they're onto something. And when Dems are found out to be behind it, the Dems of all stripes will have hell to pay. The Finance Wing (FKDuP) may be behinds this, but even Democrats from the Democratic Wing of the Democratic Party will have lost credibility.

Republican wet dream. Mess up Medicare and their fingerprints aren't even near the debacle. Just Obama's and his Inner Republican...and Dem poliicians, trashing their party's reputation.

The article lists how the plans are to keep the BHIP comfortable and profitable.

*BHIP--Big Health Industry Players

Via mablue2's Breakfast Read at The Confluence. Great aggregating with commentary.

Submitted by jawbone on

Gee, wonder what he's basing that decision on....

Investor guru Warren Buffett bought up millions of shares of health care and drugmaker stocks in recent months while shedding energy shares, according to a Friday filing with the Securities and Exchange Commission.

In his biggest acquisition of the second quarter, Buffett's Berkshire Hathaway (BRK.A) investing company added nearly 4 million shares of drug and consumer product maker Johnson & Johnson (JNJ, Fortune 500), bringing his tally to nearly 37 million shares.

Buffett also bought 1.2 million shares of laboratory equipment company Becton Dickinson & Co. (BDX, Fortune 500) He did not hold shares in this company in the second quarter.

Via Commenter Stateofdisbelief at The Confluence

Submitted by hipparchia on

i'm for it. or something.

mayo clinic whinging on medicare, and the public option. and they're not taking new medicare patients at their facility in arizona either.

if they were having trouble balancing their books back when medicare had a director and was paying rather freely [the new-and-improved-medpac is supposed to cut medicare payments to providers, not raise them], why should we listen to mayo on health care policy?

Bryan's picture
Submitted by Bryan on

Obama is just waiting for the right moment to announce he has selected Dick Armey to head Medicare and display his bipartisanship. [/sarcasm (I hope)]

Health care is a life or death issue for people. It is past time to make it a life or death issue for the Democratic Party. If they can't at least pretend that they care that people are dying while they play games, it is time to find a new party to support.

The South shifted to the Republican Party extremely quickly over Civil Rights, so it has happened in the recent past. If people start voting on a different line, the responsive politicians will follow, just as the Dixiecrats became Republicans.

If they aren't going to do anything for people, don't support them.