Just this evening, the Senate voted to confirm Marilyn Tavenner as head of the Centers for Medicare and Medicaid Services. Of the many appointed positions in the federal government, this one doesn’t sound exciting. And it isn’t. But it is important. As head of CMS, Tavenner will be responsible for overseeing both programs and implementing large parts of the Affordable Care Act, President Obama’s health care reform law.
In case it slipped your mind during all this talk of scandal and impeachment, official Washington has spent the last couple of years gnashing its teeth about the budget deficit. Even as European austerity policies threw the continent into a period of extended despair, Republicans and their allies in the well-appointed conference rooms of "centrist" think tanks told us sternly that unemployment would have to wait; the most immediate crisis was the deficit.
Within hours after the news broke that the Internal Revenue Service singled out Tea Party and other conservative groups that had applied for tax-exempt 501(c)(4) status for extra scrutiny, conservatives were already complaining that the story wasn't getting enough play in the media. "Imagine if this had happened under President Bush!" they cried. For starters, it actually did. In that case, it was the FBI, not the IRS, that went after liberal groups under the pretense that they might be harboring al Qaeda terrorists (after all, it's well known that the first thing a sleeper cell does when they get to the U.S.
When Jim DeMint left the Senate to assume command of the Heritage Foundation, some people questioned the wisdom of the move. Not from DeMint's perspective—after all, instead of being a staunchly conservative member of the minority party with a staff of a few dozen whose job was to throw rhetorical bombs at the majority and say mean things about Barack Obama, now he'd have a staff of a few hundred and rule one of the right's most important institutions, not to mention probably quadrupling his salary. No, the puzzle was why a think tank like Heritage would want someone like DeMint, not known for putting much stock in thinking, as its leader.
The Affordable Care Act contained many provisions meant to help "bend the curve" of heath-care costs, including cuts to provider payments, incentives for doctors and hospitals to keep patients healthier, and pilot programs to test innovative new ways of providing care. It also included the Independent Payment Advisory Board (IPAB), a group of medical experts who would evaluate treatments, drugs, and the like to see if Medicare was getting the most bang for its buck.