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White House budget director grilled on health plan details

Erica Werner

WASHINGTON — President Barack Obama’s budget director rebuffed congressional demands for specifics on the administration’s billion-dollar-plus plans for health care, telling lawmakers that deciding how the money is spent is largely up to them.

That response from Peter Orszag, director of the White House Office of Management and Budget, frustrated Republicans and a few Democrats on Tuesday as the Senate Finance Committee held the first of many hearings on Obama’s plan. The president’s budget calls for a 10-year, $634 billion “down payment” on extending coverage to 48 million uninsured Americans.

“Let me just note immediately, so that perhaps we can avoid the typical Washington game of ‘gotcha,’ the administration has been very clear that we put a significant down payment on the table,” Orszag said.

“But on exactly what the administration does and does not favor on the benefits and coverage side, you should not expect and you will not be receiving definitive answers from me,” he said.

That didn’t satisfy the top Republican on the panel, Iowa Sen. Chuck Grassley, who raised his voice to complain that Obama’s proposed cuts to private insurance plans serving Medicare could hurt rural America.

“How many beneficiaries would lose their benefits?” Grassley asked.

Orszag said he’d have to get back to the senator with an answer.

The committee chairman, Sen. Max Baucus, D-Mont., has pledged that his committee will pass a comprehensive health reform plan by early summer. But he has questioned elements of Obama’s “down payment” for expanded coverage.

Half that money is to come from cuts in government health programs, particularly Medicare’s private plans, and half from tax increases over a 10-year period.

Baucus reiterated his view that the administration should look for savings in the current system.

“Shouldn’t we find a way to recognize the savings, find the savings?” Baucus said.

Orszag started to explain why it was difficult to do so.

Baucus interrupted: “I didn’t say it’d be easy.”

Orszag noted that one problem is that potentially cost-saving approaches such as more efficient treatment or giving doctors incentives for quality rather than quantity of care hadn’t been measured.

“One of the frustrations is there has not been enough research done on quantifying the things we’re talking about,” he said.

Experts have estimated the total cost of covering all Americans at $1 trillion, but Orszag demurred when questioned on the overall cost. He said it would depend on the plan, reiterating that all options are on the table.

All members of the committee seemed to agree on the need to achieve comprehensive health reform. But the difficulty of reaching consensus was underscored as one senator after another mentioned a specific issue with Orszag — from home health care to generic medications to purchasing drugs from other countries — then often left the hearing room after he answered the question.

(Associated Press)