Analysis

Health care bill faces uphill battle in Senate

Compromises likely as Sen. Reid seeks votes to pass reform

Sheryl Gay Stolberg / New York Times

Washington -- As health care legislation moves toward a crucial airing in the Senate, the White House is facing a growing revolt from some Democrats and analysts who say the bills Congress is considering do not fulfill President Barack Obama's promise to slow the runaway rise in health care spending.

Obama has made cost containment a centerpiece of his health reform agenda, and in May he stood up at the White House with industry groups who pledged 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.

Experts say the measures 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, has also sounded skeptical. "My assessment at this point," Wyden 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.

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 doctors and hospital groups, who have signed onto the legislation and are lobbying hard to keep the current fee-for-service system from being phased out too quickly.

The debate underscores a fundamental tension inside the White House between cost-containment idealists and pragmatists.

Sen. Susan Collins, R-Maine, whose vote the administration is courting, convened a news 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 in an interview. She added, "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. But how much is not clear.

Still, it is one thing to wring savings out of a bloated system, quite another to change the way that system does business.

Experts agree that the Senate Finance bill does 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 other people, union workers with generous benefit plans.