Editorial November 3, 2017



The word to look at is ‘honorable’, part of the title one carries as a Member of Congress. Synonyms for that word include acclaimed, brilliant, dignified, and esteemed. Among the antonyms we find corrupt, deceptive, devious and dishonest.

So when an Honorable Member of Congress present a bill whose title is deceptive we are left to wonder what that Member is trying to do.

Case in point this week is HR 849, a bill whose title tells us that it will preserve senior’s access to Medicare. Since seniors already have access to Medicare curiosity is peaked. While the bill does nothing to impact senior access to Medicare it does something else that is a bit difficult to determine unless you take the Aristotelian approach and look at was is really there.

What the bill would do is disband the Independent Payment Advisory Board (IPAB) that was created as part of the Patient Protection and Affordable Care Act. Not only does the Board have nothing to do with senior access to Medicare but neither does disbanding it.

The 15 member IPAB is required to make proposals to reign in Medicare spending when it reaches a point and may not include any recommendation to ration health care, raise revenues or Medicare beneficiary premiums, increase Medicare beneficiary cost-sharing (including deductibles, coinsurance, and copayments), or otherwise restrict benefits or modify eligibility criteria and may include recommendations to reduce Medicare payments under parts C and D, such as reductions in direct subsidy payments to Medicare Advantage and prescription drug plans. (Legal Information Institute). The only role Congress has in the effort is to pass legislation it thinks is necessary.

You might think, as we have been trained to do, that while the watchdog group is important as Medicare spending increases this disingenuous bill and its title are just looking to free up some money to fuel the forthcoming tax reform / cut legislation. In this situation you can’t even do that because there is a pretty strong argument that passing HR 849 into law will increase the deficit over ten years by $17 billion.

CBO estimates that enacting H.R. 849 would increase direct spending by $17.5 billion over the 2018-2027 period. That estimate is extremely uncertain because it is not clear whether the mechanism for spending reductions under the IPAB authority will be invoked under current law for most of the next ten years.”

Following the federal budget and budgeting can be mysterious to say the least but what we know about this bill is that by ending the IPAB $17.5 billion may be lost from the Treasury. But what is really lost and is probably what is behind this deceptively titled bill is a Board that has the goal and authority to protect Medicare recipients from increases in premiums or loss of benefits when Medicare spending is projected to increase beyond the agreed upon rate of inflation.

There is an argument in favor of the bill and that is that the IPAB answers to no one and since it can’t hurt beneficiaries when it looks for spending reductions it may require less payment to physicians.

Considering the frame of mind this Congress has regarding the Affordable Care Act what are we likely to get if Medicare spending is left up to Congress? The current Congress already has Medicare in its sights for spending reductions or turning it into a voucher system.

So, to the bill sponsor Rep. David P. Roe [R-TN-1] we must say it is a tangled web we weave…

Hamilton on Congress

A Sobering Look Beyond the Election

By Lee H. Hamilton



Do ordinary citizens still have a voice in Washington and in their state capitals? Despite the cynicism of these times, my answer is, yes, we do… But we have to exercise it.

I don’t just mean going to a town hall meeting and yelling, or shooting off a letter or email. I mean making an appointment to sit down with your representative – in his or her office, at a cafe in the district, or wherever else you can meet – and holding a real conversation. We don’t do this often enough in our country, perhaps because most people think it’s impossible to arrange. It’s not, although it might take patience to get an appointment with a busy representative. And to my mind, it’s the most effective way for citizens to communicate with their representatives.

This is important because the heart of a representative democracy does not lie in its electorate, or even its elected officials. It rests in the communication between them, in the give and take that allows each to understand the other. Over my years in office I noticed a few things about how to make this conversation more fruitful and effective, and, for what it’s worth, I pass them along.

My guess is that in almost all cases, the representative will be gracious, attentive, and welcoming; he or she will see the meeting as a chance to reach out and perhaps win a constituent’s support. What makes the difference in these meetings is the manner in which the voter approaches them.

So my first comment is that you want to keep the discussion respectful and polite. Incivility and confrontation are counter-productive. If you want to have an impact, do not be argumentative or confrontational. Explain how the issues affect you personally and make it clear that you’re seeking to establish ongoing communication, not just a ‘one and done’ meeting.

If your representative comes to respect you because of your approach and your knowledge, that’s an important step forward in expanding your influence. Because don’t forget that the reverse can also be true: You’ll make it easy to ignore you by behaving ungraciously.

This next part may seem daunting, but it shouldn’t be: Do your homework. It goes without saying that you should identify yourself and whoever else is with you, let your representative know whom you’re representing – don’t exaggerate your numbers – and above all, make it very clear what you want him or her to do or not to do. And you’ll be far more effective if you’re well-informed about the core facts on the issues and about the person you’re speaking to: his or her party, length of service, committees, interests, views, ratings and priorities.

Understand that legislators deal with many challenging relationships: voters, donors, constituents, interest groups, party officials, congressional or legislative leadership, governors and presidents, and an array of others. So, listen carefully and ask a lot of questions, and get clarity about where your representative stands on your issues and why. Test his or her knowledge of the issues, and the depth of commitment to the views he or she takes. Be firm in insisting on direct answers, but don’t be adamant or unreasonable. If you want to, record the session, but be sure to advise the representative you are doing so.

In short, having a productive conversation with elected representatives comes down to being informed, remaining courteous, being curious and open to dialogue yourself, and stating your views and understanding of the issues as clearly as possible.

If you engage in this fashion with your representatives on a regular basis, I think you’ll have reason to be satisfied that you’re stepping up to your responsibilities and raising your effectiveness as a citizen. And if conversations of this quality are multiplied across the country, it really will improve the quality of our representative democracy and contribute to the direction and success of our country.

Lee Hamilton is a Senior Advisor for the Indiana University Center on Representative Government; a Distinguished Scholar, IU School of Global and International Studies; and a Professor of Practice, IU School of Public and Environmental Affairs. He was a member of the U.S. House of Representatives for 34 years.

Magic Mondays

Political ‘Education’