WASHINGTON — The White House is facing a growing revolt from some Democrats and analysts who say the health care bills being considered by Congress do not fulfill President Barack Obama's promise to slow runaway increases in health care spending.
Obama has made cost containment a centerpiece of his health care agenda. In May, he stood up at the White House with industry groups who pledged to make voluntary efforts to trim the growth of health care spending by 1.5 percent, or $2 trillion, over the next decade.
But the bills, including one passed Saturday night by the House, are unlikely to meet that goal, analysts say.
Analysts — including some who have consulted closely with the White House, like Dr. Denis Cortese, chief executive of the Mayo Clinic — say the measures would take only baby steps toward revamping the current fee-for-service system, which drives up costs by paying health providers for each visit or procedure performed.
Sen. Ron Wyden, D-Ore., a member of the Finance Committee who has worked on health policy, sounded skeptical.
“My assessment at this point,” he said, “is that the legislation is heavy on health and light on reform.”
There are a variety of ideas for attacking cost increases more aggressively, including setting Medicare reimbursement rates for doctors and hospitals more rigorously and discouraging workers and employers from buying expensive health insurance policies that mask the true costs of treatment.
Health economists are increasingly advocating a cost-cutting method known as “bundling,” in which health providers receive a lump sum to care for a patient with a particular medical condition, say, diabetes or heart disease. The House bill calls for the administration to develop a plan for bundling; the Senate Finance Committee version of the bill would give officials until 2013 to create a pilot program.
Senators of both parties say they will press for more aggressive cost-cutting measures when the bill comes up for debate.
But drastic changes in the health care reimbursement system could cost the White House the support of doctor and hospital groups, which have signed onto the legislation and are lobbying hard to keep the current fee-for-service system from being phased out too quickly.
Sen. Susan Collins, R-Maine, whose vote the administration is courting, held a press conference on Monday with Sen. Lamar Alexander of Tennessee, a member of the Republican leadership, to spotlight her concerns over cost containment. Collins said she had been meeting with a group of moderate Democrats who shared her views.
“I don't believe we need more pilot projects to show us that health care delivery reforms are necessary,” she said.
“I think people are much more upset over the cost of care than the administration is acknowledging.”
Both the House and the Senate are proposing cost-saving measures. The House bill projects $440 billion in Medicare savings over 10 years; the Senate Finance Committee bill projects about $420 billion.
White House officials say there will be additional, substantial savings in the private sector as well. How much is unclear.
Still, it is one thing to wring savings out of a bloated system, quite another to change the way that system does business.
Analysts agree that the Senate Finance bill would do more to put systemic changes in place. That is because the bill includes two measures that health economists favor: a tax on high-value “Cadillac” health plans, and an independent commission that would make binding recommendations on how to cut Medicare costs.
House Democrats strongly oppose the Cadillac tax, which would hurt, among others, union workers with generous benefit plans. But Nancy-Ann DeParle, director of the Office of Health Reform, said she sensed fresh House interest in the Medicare commission idea.
“There is a lot of support for cost-containment,” she said.
