After the Senate eliminated the filibuster on most nominations, the focus has been on judges, and rightly so.
However, one of the lesser-appreciated parts of the power of the Senate to run under majority rules is that now Democrats can fully stock the death panels and get to work denying care to those pesky, expensive senior citizen-- darn it, I just let the cat out of the bag.
All jokes aside, the demise of the filibuster does lift one of the major hurdles to getting what could be a critical part of the Affordable Care Act's bureaucracy running -- the Independent Payment Advisory Board.
The idea behind the IPAB is simple -- if Medicare spending per-person spending increasing increases by a number more than, a panel represents cuts. Those cuts can't charge recipients more or deny access to Medicare.What they can do is limit reimbursements to providers for certain procedures or possibly pharmaceuticals. (See the ever helpful Kaiser Foundation for an overview)
This ability to say "no" is pretty constrained, but it should get providers' attention and grant Medicare some new leverage to keep costs down. (Think about how much lower drug costs are at the VA where the system negotiates drug prices across the system; the IPAB doesn't have that much power for Medicare, but it moves it in the right direction; better yet, the board can make some recommendations for private health insurers, which should do a bit more to cut costs)
Better yet, the system fast-tracks any recommendations through the House and Senate, where they automatically take effect unless both branches vote with 3/5s of their members to reject them and replace them with other cost savings (which means that some lobbyists' jobs just got a lot tougher).
The president appoints 15 people -- 3 nominees from himself, and three each in consultation with the majority and minority leaders of both houses of Congress. the GOP has been refusing to consult on their six members, but will likely be more likely to bargain now that the Democrats will be able to get their nine members confirmed through the Senate over GOP opposition.
All this is moot for now -- because Medicare expenses increased by 1.15 percent last year, but thanks to getting rid of the filibuster,controlling health care costs in way that won't hurt patients is about to get a lot easier.