The government is the payer, Orin, not the decider. Democrats must repeat
ad nauseum that it is the insurance company bureaucrats denying people care, raising their rates, and canceling their coverage when they get sick.
That said. Medicare needs someone to control costs. That is why Obama wants Congress to set up a medical advisory council (IMAC) to do just that.
The theory underlying IMAC is that Congress cannot do health-care reform, err, RITE. It is too captured by special interests and too baffled by technical arguments and too paralyzed by partisanship. Leaving the continual tweaks and hard decisions that will bend the curve over the long term up to Congress is a bit like asking JD Salinger to blog: It might happen occasionally, but it's not a safe bet. The IMAC proposal substantially removes Congress from the process. The letter that Peter Orszag sent to Nancy Pelosi explained how it would work:
This draft bill would establish an Independent Medicare Advisory Council (IMAC), which would have the authority to make recommendations to the President on annual Medicare payment rates as well as other reforms. Both the annual payment updates and the broader reforms would be prohibited from increasing the aggregate level of net Medicare expenditures. This proposed legislation would require the President to approve or disapprove each set of the IMAC’s recommendations as a package. If the President accepts the IMAC’s recommendations, Congress would then have 30 days to intervene with a joint resolution before the Secretary of Health and Human Services is authorized to implement them.
http://voices.washingtonpost.com/ezra-klein/2009/07/the_dull_reality_of_change.html