Democrats split over entitlement reform as “fiscal cliff” looms

The Center for American Progress recently outlined changes to Medicare and Medicaid it suggested liberals can live with. Ezekiel Emanuel, a former Obama administration official and one of the report’s authors, said health services should be paid according to a patient’s condition or outcome, not for each medical service provided. He also said the programs would benefit from more competitive bidding and that states should be rewarded when they lower costs.

“We don’t want the Republican idea that under rubric of ‘entitlement reform’ you dismantle or privatize the programs,” said Mr. Emanuel, who heads the Department of Medical Ethics and Health Policy at the University of Pennsylvania. “But we also don’t agree with saying there is no real long-term problem. Both of those extremes are misguided.”

Mr. Durbin said Mr. Emanuel helped convince him that changes could be made to Medicare that preserve the program’s mission. He said other Democrats should do similar consultations.