A White House proposal to set up an independent council to set Medicare fees and other changes to the government health program for the elderly could save up to $2 billion from 2016 through 2019, the Congressional Budget Office said on Saturday, according to Reuters. The nonpartisan CBO said, however, that the plan, if added to a sweeping healthcare reform bill, could also easily produce no additional savings because it lacks specific goals and proposes no "fall-back" mechanism to ensure cost-reduction objectives are met. "The estimated savings of $2 billion over the latter half of the 2010-2019 period represent a probabilistic assessment of a range of possible outcomes," CBO director Douglas Elmendorf wrote in a letter to House of Representatives Majority Leader Steny Hoyer and other congressional leaders. Elmendorf said it was unlikely an independent rate-setting council appointed by President Barack Obama would recommend actions that would add "substantial additional savings" to those already anticipated under the main healthcare reform bill. He said the council might be weighted toward medical providers who might not be inclined to recommend deeper cuts in provider payments. Further savings also may be limited without more substantial changes to the structure of payments and incentives to medical providers -- something that would require politically difficult legislation. The plan also needs a fall-back mechanism to ensure that some minimum spending cuts are achieved. That mechanism could include an across-the-board reduction in payments if goals for cost reduction are not met, he said. More substantial savings could be achieved if that and other enhancements were approved, including the setting of specific, feasible goals and giving the president's council clear authority to recommend broad coverage changes to coverage, benefit design and payment systems. Those savings could reach "several percent" of annual Medicare spending in the years beyond 2019 -- a level that would reduce Medicare outlays by tens of billions of dollars annually. "Substantial additional savings from an Independent Medicare Advisory Council-type proposal would probably require significant changes in coverage, benefit design, and payment and delivery systems aimed at reducing the quantity and intensity of services provided," Elmendorf wrote. The federal Medicare program insures some 44 million elderly and disabled Americans at an annual cost of about $450 billion, almost one-fifth of total U.S. healthcare spending.
