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Medicare retooling hashed out

Sat., July 25, 2009

After debate, House Democrats agree to reforms

WASHINGTON – House Democrats announced agreement Friday on far-reaching steps designed to rein in the relentless growth of Medicare, part of a concerted effort to counter the impression that President Barack Obama’s health care legislation is in deep trouble.

Speaker Nancy Pelosi hailed the agreement as a “giant step forward” for the bill that Obama has made a test of his leadership. Advocates said it eventually would turn Medicare toward a program that rewards quality rather than volume, as well as alter a system that pays doctors and other providers more in some regions of the country than others.

Yet the leadership all but abandoned a pledge to approve legislation before a monthlong vacation scheduled to begin at the end of next week.

Separately, talks between the leadership and rebellious conservative and moderate Democrats demanding changes in the bill collapsed in acrimony during the day, then were revived with a handshake a few hours later.

The maneuvering in Congress came as Obama met at the White House with Senate Majority Leader Harry Reid, D-Nev., and Sen. Max Baucus, D-Mont., the chairman of the Finance Committee, who has been trying for months to produce a bipartisan agreement.

“I said to him (Obama) what I say to everybody. We are ready when we are ready,” Baucus later told the Associated Press in an interview.

Across the Capitol, Pelosi virtually ordered a small group of Democrats from rural and urban areas to thrash out their differences Thursday night on Medicare issues that sound arcane, but matter enormously to individual lawmakers and likely will also lead to cuts in spending growth.

Lawmakers said the agreement would lead to changes in Medicare to try and reward doctors, hospitals and other providers for high-quality care. Critics argue the current system simply pays by volume – compensating providers regardless of whether additional medical procedures contribute to better health care.

Under the agreement, the Institute of Medicine would complete a study by September 2011 recommending changes in the current structure for determining reimbursement. The administration would have 45 days to submit the report to Congress, and it would go into effect unless Congress blocked it by the end of February 2012.


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