Orszag Demands IMAC, To Take Decision-Making Out of Elected Government's Hands

July 24, 2009 (LPAC)—Peter Orszag, head of the White House Office of Management and Budget and reputedly the key architect of President Obama's health care reform program, at least twice yesterday called for the Administration's proposed Independent Medicare Advisory Commission (IMAC), as a means of removing decisions about policy of the government's Medicare program from "the politicians," and into the hands of "professionals." For those with a sense of history, Orszag's demand chillingly echos the claims of the Italian Fascists in the early 20th Century, that Italy's problems were caused by corruption, inefficiency, and stupidity of the nation's elected political class, who should be replaced by a government of technocratic experts. This time, the role of the strutting, shouting macho Mussolini, is taken by a nasal-voiced, propeller-beanie accountant, Peter Orszag.

Orszag, who has paralleled the President in the last two days' Health Care Reform roadshow in multiple appearances to push their product, addressed the Council on Foreign Relations in New York yesterday, in a speech titled "New Foundation for Growth." After an extended survey of the Administration's response to the economic crisis, Orszag told the elite CFR audience that "The evidence is clear that the biggest threat to our fiscal future is rising health care costs." (So much for the sales-line to the mickeys, that health reform is to improve Americans' health, and costs are simply a problem in achieving that.) After elaborating on that assertion, and then on the Administration's mantra of "better care, rather than more care," Orszag introduced the IMAC proposal, saying that one of the key reasons to implement IMAC, is to "help to insulate Medicare policy decisions from undue political influence." After admitting several times that "The truth is that we don't know today all of the steps that are necessary to move towards providing higher-quality, lower-cost care" — without explaining, what knowledge "the professionals" can thus provide — Orszag nevertheless intoned, "But moving more decisions into the hands of medical professionals and out of the political process will enable us to continually update the system to reflect new information and changed circumstances...."

The first segment of last night's Charlie Rose talk show on PBS television featured an interview with Orszag. He told Rose, that among the steps in transforming the health care system, along with health IT and comparative effectiveness research, is "a big proposal that we've put on the table, a change in the way Medicare policy is set, so that we can move decision-making out of the hands of politicians." To Rose's question, "Away from Congress and the executive branch?" Orszag affirmed that he means to transfer that decision-making to IMAC.

Today, the White House held a telephone conference call for regional press, with OMB Director Orszag. The announcement said the conference would discuss the economic case for health reform laid out in his address to the Council on Foreign Relations, and indeed, Orszag's brief opening remarks, solely about healthcare reform, tracked the central themes and language of his CFR speech. Strangely, Orszag's prepared remarks omitted any reference to the name or concept of IMAC, and he only mentioned it late in the conference, in answer to a question about how to stop the costly advertising and other cut-throat efforts of competing local hospitals.

The IMAC-pushers echo Obama's presidential campaign rhetoric about lobbyists and politicians causing the crisis of governance in Washington — and lobbyists such as Jack Abramoff have certainly proven to have been scoundrels. It should be recalled, however, that the "political influence" and "political process" which Orszag decries, includes not only representatives of corporate America seeking business, but also average American citizens making requests and demands on Congress — such as adequate health-care provision for senior or impoverished citizens. The First Amendment to the U.S. Constitution calls it, "the right of the people ... to petition the Government for a redress of grievances." Of course, the Constitution describes that Government as a Congress and President chosen by those same people, by means of elections. Look it up, as the saying goes.