The Center for American Progress (CAP) on Wednesday released a proposal that would cut $385 billion from U.S. health care expenditures without shifting the burden of costs onto America’s seniors and the middle class.

Dubbed “The Senior Protection Plan,” the proposal was unveiled in the face of impending budget negotiations between President Obama and Congressional leaders that will have enormous consequences for the federal safety net, particularly Medicare and Medicaid. While Obamacare has already made significant cuts to health spending, patient advocacy and provider groups have expressed concerns that a forthcoming “grand bargain” aimed at further reducing the federal budget deficit might be brokered on the backs of poor, elderly, and sick Americans.

Instead of instituting cuts that would only nominally reduce health care spending by cutting Americans’ health benefits and raising their premiums and out-of-pocket costs — as Republican proposals to slash Medicaid funding and turn Medicare into a voucher program would do — CAP’s plan hones in on the systemic factors that drive long-term medical inflation. Here are five proposals from the Senior Protection Plan aimed at cutting national health costs in a fair manner while improving the efficiency and quality of health care delivery to elderly and low-income Americans:

1) Reduce low-income Americans’ prescription drug costs. Drug manufacturers pay significantly lower rebates for drugs provided to Medicare beneficiaries than they do for drugs provided to Medicaid beneficiaries. This has led to drug companies shifting prescription drug coverage for so-called “dual eligibles” — particularly sick and poor Americans who qualify for both Medicare and Medicaid — from the Medicaid program into the Medicare prescription drug plan, allowing the companies to reap massive profits without providing these vulnerable Americans any tangible benefit. The Senior Protection Plan would extend the higher Medicaid prescription drug rebates to brand-name medications purchased by dual eligible, low-income Medicare beneficiaries, leading to more affordable drug coverage for the poorest Americans as well as significant cost savings in the lucrative drug industry. Altogether, these proposals would reduce spending by $160 billion.

2) Curb waste and excessive payments to Medicare providers. The plan calls for an additional $88.6 billion in savings by bringing Medicare reimbursement rates in line with the actual costs of care while rooting out fraud and administrative waste in the program. Skilled nursing facilities, rural hospitals, and home health providers currently receive as much as $33 billion in excess payments, while Medicare overpays hospitals for inpatient services that are no more complex or time-consuming than less costly outpatient procedures. While the Obama Administration has been aggressive in cracking down on fraud in Medicare, the Senior Protection Plan finds even more savings by asking providers and caregivers to share eligibility, claims, and benefits information electronically, while aggressively pursuing perpetrators of Medicare billing fraud.

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This afternoon, Center for Medicare and Medicaid Services (CMS) chief Don Berwick announced that he would resign next week, following strong Republican opposition to his recess appointment and slim chances of winning Senate confirmation for a full term. The former pediatrician and Harvard professor — who has spent his career developing ways to improve care quality — came under intense criticism from Republicans for praising the British health care system and suggesting that the government should play a larger role in controlling health care spending.

Berwick’s resignation is not a reflection on his performance. He has overseen crucial initial reforms and established a vision that will help the agency — and his replacement Marilyn Tavenner — move forward in implementing the reform. But Republicans lined up against him in order to rally their base and shift the conversation from job creation to tearing down Obama’s signature accomplishment during an election year. Their criticism had less to do with concerns about “rationing” of care and more with preventing the Affordable Care Act from succeeding in lowering health care spending.

After all, it was the current Republican presidential frontrunner Newt Gingrich who in 2000 and then again in his 2006 book “Saving Lives & Saving Money” praised Berwick for his passionate belief that quality-care focused systems improve health outcomes and reduce health care spending — and many other conservatives (including former Bush health officials) shared and espoused this vision. From Gingrich’s 2000 editorial:

The Veterans Administration’s Palo Alto Health Care System is creating a computerized patient medical record system. The new Northwestern Memorial Hospital in Chicago was designed from its conception to be a safer, more accurate and more electronic facility. Don Berwick at the Institute for Healthcare Improvement has worked for years to spread the word that the same systematic approach to quality control that has worked so well in manufacturing could create a dramatically safer, less expensive and more effective system of health and health care.

Berwick fell to the right’s hyper politicization of health care reform and his decision to step down serves as another example of Republicans turning their backs on their own ideas in order to attack the president and his health care law.

Republicans have long opposed Dr. Don Berwick, the current head of the Center for Medicare and Medicaid Services, pointing to the Harvard professor’s respect for the British health care system and other European models as evidence that he supports “socialized medicine” and would support government-centered rationing of health care in the United States. “I believe the President of the United States now has what he wants, his health care rationing czar,” Sen. John Barrasso (R-WY) said on the floor of the Senate. “We have a president — a president-appointed czar, essentially a czar to ration health care.” Sen. Pat Roberts (R-KS) expressed similar outrage after Berwick was nominated for the position, saying, “Dr. Berwick is the perfect nominee for a president whose aim has always been to save money by rationing health care.”

But not all prominent Republicans oppose Berwick. In fact, it turns out that 2012 presidential hopeful and former Speaker of the House Newt Gingrich was once a strong promoter of the CMS administrator, praising Berwick for what Republicans are now characterizing as “rationing” — his work to improve the quality of the nation’s health care system. In early part of the last decade, Gingrich “gave credibility and visibility to a set of ideas being talked about in the health policy world about using information technology to improve medical care.” He advocated “reforms such as ‘data-driven reimbursement’ informed by best practices, a national electronic health network and a focus on prevention and wellness. All those items — and others Gingrich supported — are contained in the HITECH Act, part of the budget stimulus package and the Affordable Care Act,” Michael Millenson notes.

An Amazon search of Gingrich’s “Saving Lives & Saving Money” reveals three separate references to Berwick — who was and still is a national leader in improving health care quality — in which Gingrich praises the current CMS head for his passionate belief that quality-care focused systems improve health outcomes and reduce health care spending. Gingrich even included a plug for Berwick’s nonprofit, the Institute for Health Improvement, reprinting the organization’s website on page 122 of his book. In an August 2000 Washington Post op-ed calling on President Bill Clinton to “stop defending inefficiency and to drag health care into the 21st century by insisting on modern management and information systems,” Gingrich singled out Berwick for spreading the word about “quality control”:

The Veterans Administration’s Palo Alto Health Care System is creating a computerized patient medical record system. The new Northwestern Memorial Hospital in Chicago was designed from its conception to be a safer, more accurate and more electronic facility. Don Berwick at the Institute for Healthcare Improvement has worked for years to spread the word that the same systematic approach to quality control that has worked so well in manufacturing could create a dramatically safer, less expensive and more effective system of health and health care.

In July of 2010, however, Gingrich slammed President Obama for recess appointing Berwick to CMS, describing the decision as “a sad mistake” and used Berwick’s appointment as evidence for how “left” Obama is.

“I described it as a secular Socialist machine in a book I wrote recently. And I think what you saw [Obama] do with Dr. Berwick is a good example of machine behavior,” Gingrich said during a July 8, 2010 appearance on The O’Reilly Factor. He added: “Among the elites, there will be great applause for Don Berwick. Among the rest of the country, there will be a very chilly attitude that says is this guy really going to try to impose a British national healthcare system in America? And so, there’s a real split emerging in the country. But among the people in the White House, my hunch is almost all of them uniformly agree with what he’s doing and uniformly believe that somehow they’ll find a way to sell it.”

CMS Head Don Berwick

Republicans have spent the lat two years going after CMS head Don Berwick for allegedly trying to ration care and establish some sort of centralized health care system, but now the man the GOP has labeled Obama’s ‘Health Rationing Czar‘ is telling Politico’s Jennifer Haberkorn that Rep. Paul Ryan’s (R-WI) proposals to voucherize the Medicare program and block grant Medicaid would withhold care from people:

“It is paradoxical really that with all this talk of rationing, the proposal we hear about how to fix American health care is to take it away from people. That’s from the very people who are crying rationing,” Don Berwick, the administrator of CMS, said in a wide-ranging interview with POLITICO. “If you look at the proposed withdrawals of support to Medicare beneficiaries and Medicaid, it’s withholding care from the people who need the care. You tell me what that is?” [...]

“When I read proposals for reform that say, ‘Sorry kid, you’re on your own,’ that’s the not the country I want to be in,” he said. “And I don’t think that’s the country the public wants to be in.”

In particular, he said the idea of block-granting Medicaid — an idea endorsed by most of the likely Republican presidential nominees — has short-term attraction as governors deal with crushing budgets but is “unsound” in the long-term.

“Block grants are throwing the states out on their own,” Berwick said. “If we block grant and the next immense influenza epidemic arrives or a major recession comes back, what do we say? ‘Sorry states, you’re on your own?’”

It’s worth noting that the Affordable Care Act also cuts Medicare, but those savings would slow the growth in the program by removing approximately $500 billion from future spending over the next 10 years. It eliminates overpayments to private insurers and slowly phases-in payment adjustments that encourage providers to deliver care more efficiently. The law also gives Berwick and his agency greater discretion to experiment with alternative payment systems — so that providers are compensated for delivering care more efficiently, rather than just ordering more tests — and establishes an innovation center for payment reform.

In other words, the ACA eliminates the inefficiencies in the health care system without sacrificing guaranteed benefits. Ryan, on the other hand, keeps a lot of the waste in the system and simply cuts the federal contribution to Medicare, passing on more of the cost of coverage to seniors without looking at ways to make the program more efficient. He would force Americans under 55 years of age into less efficient private coverage and would then leave it up to those insurers to deny treatment and benefits.

This afternoon, Don Berwick, the head of the Centers for Medicare and Medicaid Services (CMS), responded to Arizona Governor’s Jan Brewer’s (R) request to exempt 280,000 residents from the Medicaid rolls in order to balance the state budget. Under the Affordable Care Act, states that change their Medicaid eligibility rules also forgo federal funding for the program. The provision has placed many governors in a tough fiscal conundrum and has led some to seek leeway in the law.

Appearing at Family USA’s annual Health Action Conference, Berwick hinted that the agency would deny Brewer’s waiver request. He pledged to work with the states to help them meet their requirement, but urged governors like Brewer to take a longer view of reform:

BERWICK: I’m fully aware of the stress and distress that states are feeling…..What we can commit to is process –- which is we will be in dialogue. We will talk with the states, we will be talking with the governors. We are already in constant contact with them, we’re going to see state by state, community by community, the best kinds of solutions we possibly have, all the while protecting the beneficiary. […] We are here to protect the beneficiaries and to help the states do that.

I’ll say the real answer here has got to be a little longer run than what the states are thinking right now. If I were a governor of a state, I’d think short term also. But you know, we’ve got to work our way out of it. The Medicaid problem, the state problem in health care is the health are problem. It’s just more vivid because of the way state budgets are run. But it’s true for the whole system. A sustainable health care system for our country is a different health care system.

Watch it:

Thirty-three Republican governors have asked the federal government for a waiver to cut back on their existing Medicaid program without losing federal funding, and Arizona has previously jumped through some fairly small legislative hoops to avoid giving up this revenue stream. In March, the Arizona legislature eliminated funding for KidsCare, the state’s CHIP program, only to reestablish it months later in order to avoid losing billions of dollars in federal matching funds.

Last night, the White House announced that it was re-nominating Berwick, who was recess appointed last year after sparking controversy with Republicans.

This afternoon, Center for Medicare and Medicaid Services (CMS) chief Don Berwick — who was recess appointed by President Obama — appeared before the Senate Finance Committee to answer questions about the agency’s progress in implementing the Affordable Care Act. Since Obama first nominated Berwick, Republicans accused the physician and former Harvard professor of rationing care, denying payment for treatments based on cost effectiveness and mirroring reform on the British model. They’ve repeatedly asked for Berwick to testify before Congress and today was their first opportunity to question him publicly.

Health care reporters expected the much-anticipated hearing to take the form of a duel between Republicans, who wanted to use their time to build opposition to the law, and Democrats, who saw this as an opportunity to make their argument against repealing it. But this morning, neither side had enough time to plead their case.

Finance Committee Chairman Max Baucus (D-MT) ended the hearing after just an hour and 20 minutes, citing a pending vote. And even though senators from both parties had approximately five minutes each for questions, Republicans wasted a remarkable amount of time complaining they wouldn’t have enough time to ask their questions:

SEN. CHUCK GRASSLEY (R-IA): “There is at least 70 minutes of questioning here and we have votes starting at 11. So I was wondering if you you’d commit to appearing again before the committee after the Thanksgiving break so that we’d all had a chance to ask the questions we want to ask.”

SEN. PAT ROBERTS (R-KS): “Five minutes, obviously I can’t do this, I have other obligations, I have to leave and I apologize for that.”

SEN. ORRIN HATCH (R-UT): “This is pathetic…my gosh we ought to have time to ask the most important man in America on health care questions that are relevant and important.”

SEN. JIM BUNNING (R-KY): “The opening statements took almost 30 minutes, although Senator Baucus won’t make a commitment to have you come back to testify before the end of the year, I can assure you will not get special treatment next year.”

Watch a compilation:

Baucus did not commit to holding hearings with Berwick after Thanksgiving, but said, “it is my intention to have a good number of hearings, because it’s very important for this committee to hear from the CMS administrator about his plans.”

During the hearing, Grassley also questioned Berwick about potential conflicts of interest, Hatch asked about so-called double counting of Medicare savings, and Bunning demanded to know why Berwick had accepted a recess appointment. On the Democratic side, Sen. Debbie Stabenow (D-MI) had Berwick explain the consequences of repealing the law and Sen. Ron Wyden (D-OR) extracted a commitment to focus on state innovation. You can read Berwick’s opening statement here.

Refusing to allow Republicans to delay implementation of reform any longer and trying to avoid a Republican hold, President Obama recess appointed Harvard Professor Don Berwick to head the Center for Medicare and Medicaid Services (CMS), a position vacant since 2006. Republicans, who had had characterized Berwick as a proponent of “health care rationing,” took to the Senate floor to condemn Obama for installing Berwick before he even had a chance to appear before the Senate Finance Committee. The GOP admitted that they had criticized the nominee but argued that they had not held up his nomination and would have treated his confirmation fairly:

- SEN. JON KYL: (R-AZ): But for anybody to suggest that Republicans are to blame for the fact that Dr. Berwick’s nomination didn’t come to a vote or wasn’t brought to the senate floor is sheer fantasy. We have not held up the nomination. We have not prested a vote. We haven’t — We have not prevented a vote. [7/12/2010]

- SEN. JOHN MCCAIN: (R-AZ): But where’s the evidence of delay in Berwick’s case? It can’t fairly accuse the other side of political gamesmanship when you short circuit the process and storm off the court before the first set. [7/13/2010]

- SEN. CHUCK GRASSLEY (R-IA): The nomination hasn’t been held up by Republicans in Congress and to say otherwise is misleading. [7/7/2010]

Ironically, the Republicans are now showcasing their desire for a fair and transparent nomination process by delaying two other nominations in retaliation for Berwick’s appointment. Minority Leader Mitch McConnell (R-KY) has “blocked a Democratic request Wednesday evening to advance two of President Obama’s nominees to the U.S. Court of Appeals for the Fourth Circuit,” the Hill reports. “Democrats didn’t schedule so much as a committee hearing for Donald Berwick,” McConnell said. “So given that the President has been so dismissive of the Senate’s right to provide advice and consent under the Constitution, I am not inclined at this point to consent to the agreement proposed by my friend from North Carolina,” he added.

The GOP is also demanding to hear from Berwick, and has written a letter to Senate Finance Committee Chairman Max Baucus (D-MT) asking him to call Berwick to testify.

As newly sworn-in CMS chief Don Berwick was unveiling the new meaningful use regulations for health information technology this morning, Republican Senators took to the Senate floor to condemn his recess appointment. Sens. John Barrasso (R-WY), John McCain (R-AZ), and John Thune (R-SD) engaged in a 30 minute colloquy to blast the President for appointing Berwick ahead of his confirmation hearings. McCain even wondered, “what was the hurry? … There’s going to be another recess in August. There’s going to be another recess after — in October after — unless we go out for elections. But yet in their zeal and haste, they had to do it just over the 4th of July recess!”

The GOP regurgitated what McCain called Berwick’s “greatest rhetorical hits,” argued that Berwick’s nomination exposed the administration’s stealth agenda to ration care and tried to link Berwick to the familiar “czars” narrative:

– MCCAIN: “And I must admit that both Republican and Democrat administrations have abused the recess process — recess appointment process. Yes, they have abused it. But I must say, this takes it to a new high, or low, depending on which way you view it. We have now seen in this administration the appointment of various czars, people given responsibilities over vast areas of government as “czars.” They’ve got more czars than the Romanovs.

– BARRASSO: I believe the President of the United States now has what he wants, his health care rationing czar….but that’s what we have now. We have a president — a president-appointed czar, essentially a czar to ration health care. It’s not what the American people want.

Watch a compilation:

Barrasso insisted that Berwick would “redistribute wealth” and implied that supporters of Berwick were against the American people:

BARRSSO: It was interesting yesterday on this floor, someone on the other side of the aisle stood up and said, if you’re against Dr. Berwick, then whose side are you on?… I’m on the side of the American people, the American people who are concerned about $500 billion of cuts to their Medicare. I’m on the side of the people who believe we should not redistribute wealth in this country.

Taking Barrasso’s argument to its logical conclusion would also lead one to believe that the nation’s hospitals and doctors are also anti-American. The American Hospital Association, the Federation of American Hospitals and a host of other provider groups praised Berwick, predicting that he “will bring a wealth of knowledge and practical experience to CMS from his perspective as a physician, teacher and passionate advocate for high-quality care.” Berwick’s “experiences from his lifelong quest to find better and safer ways to deliver care will greatly inform and enhance the implementation [of] healthcare reform,” the groups wrote in letter to the Senate Finance Committee.

The group’s praised Berwick’s conception of patient [notice, not government] – centered medicine, in which “the needs and wants of the patient should come first.” For more on this approach and how it differs from Barrasso’s description, click over to Maggie Mahar’s comprehensive post here.

The GOP is growing increasingly unhinged over the recess appointment. Last week, Rep. Michele Bachmann (R-MN) agreed with a radio host’s description Of Berwick as “chairman of the Obamacare death panel.”