Health Care System in Limbo

If the U.S. Supreme Court finds the federal health care reform act unconstitutional later this year, experts say it could unravel more of the nation's health care system than anticipated, including Medicare.

Judy Feder, a former Clinton administration official, tells NPR's Julie Rovner that the push toward more integrated and coordinated health care delivery would be disrupted.

Gail Wilensky, who ran Medicare and Medicaid programs for President H.W. Bush, says voiding federal health care reform would erase the most recent benchmarks for doctor and hospital payment rates. 

"Hospitals might not get paid. Nursing homes might not get paid. Doctors might not get paid," Wilensky says. "Changes in coverage that have begun to take effect for the elderly, such as closing the donut hole, might not happen." The effects, she adds, would undoubtedly spill over to everyone in the health care system.

Sara Rosenbaum, a professor of health law, likens it a train wreck. "We could find ourselves at a grand stopping point for the entire health care system." One problem she cites is the possibility of thousands of Medicare policies being suddenly null and void.

Jeremy Lazarus, president-elect of the American Medical Association, says, "With countless hours of work already done to implement the law, it is hard to imagine the full impact of it disappearing."

Dan Mendelson, a health care consultant with Clinton administration ties, says the high court's decision could put most of health care in America in a legally murky place. Lazarus calls it "political never-never land."

Repeal or partial repeal of what Republicans like to call Obamacare would make a pretty big policy crater in Congress, which already is staring at big holes in long-term funding for Medicare and Social Security. Trustees for those entitlement programs released reports showing Medicare hits the financial wall in 2024 and Social Security's Waterloo has inched closer by three years to 2033.

More than 56 million American retirees or disabled workers and their spouses and children receive Social Security payments, which average $1,232 per month. It doesn't take a calculator to realize that is a lot of money rippling through the economy because Social Security recipients spend what they receive on food, rent, transportation, utilities and medical bills.

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Two Nerds, One Big Idea

Compromise and election-year messaging are often lightning bolts streaking in opposite directions. Congressional Republicans, intent on uprooting President Obama from the White House, have felt the tension. And so has Oregon Senator Ron Wyden, who teamed with House Budget Chair Paul Ryan on an improbable proposal to reform Medicare.

Congressional Republicans buckled to election pressures as they agreed to a compromise last week to extend a payroll tax cut, continue jobless benefits and block a Medicare fee cut to doctors.

But Wyden has no reason to buckle. A Democrat, he was re-elected comfortably in 2010 and remains one of Oregon's most popular political figures, in part because he is willing to work across the political aisle. Seeking bipartisan solutions on controversial issues is viewed today as the act of a political maverick in much the same way as Senators Wayne Morse and Mark Hatfield opposing the Vietnam War.

The Potomac Watch column in the Wall Street Journal ran a piece describing what it called the Democratic establishment's "War on Wyden” for his Medicare collaboration with Ryan. It noted New York Times columnist Paul Krugman called Wyden a "useful idiot" to Mitt Romney's presidential election bid. House Democrats, according to WSJ, "hissed the plan would end Medicare as we know it." And a former Senate staffer complained Wyden undercut a key argument for Democrats regaining control of Congress.

Even Ryan's Democratic opponent jumped on the pig-pile. The WSJ quoted Ron Zerban as saying Wyden's co-sponsorship of a Medicare plan with Ryan gave the controversial Republican political cover. Zerban added, "Wyden is no longer a Democrat."

Not following party orthodoxy is nothing new for Wyden. Branded a young liberal when he brashly defeated sitting Congressman Bob Duncan in 1980, Wyden immediately set about building a reputation centered on job creation (a new lock at Bonneville Dam) and health care reform. The former head of Oregon's Gray Panthers knew a lot then about the strengths and weaknesses of Medicare, gathered by talking personally with hundreds of men and women covered by Medicare.

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The Super Secret Committee

The 12-member congressional Super Committee has until Thanksgiving to come up with another $1.2 trillion in federal spending cuts. Since it deliberates behind closed doors, no one really knows whether it is making progress or spinning its wheels.

So the best you can do is look for clues. One top House GOP lawmaker suggested the $1.2 trillion in savings could come entirely from health care reductions.

Congressman Denny Rehberg, R-MONT, who chairs the House Appropriations subcommittee that deals with health care spending, said the savings could be achieved with two simple modifications to the federal health care reform law adopted last year. One change would knock out proposed Medicaid expansion; the other would trim subsidies to help people buy health insurance.

At the same time, the Wall Street Journal reported that nearly 50 percent of Americans live in households that receive some form of federal aid. Almost 35 percent are in households receiving food stamps, subsidized housing, cash welfare or Medicaid benefits. Almost 15 percent receive Medicare benefits and nearly 16 percent receive Social Security benefits.

Democrats are apparently rolling out their own bogeymen — subsidies for oil companies — for the chopping block.

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