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Both Republicans and Democrats agree that rising Medicare costs are the principal long-term driver of the federal deficit. They just don’t agree on how to rein in the spending. The lesson from New York’s special House election is that the Republicans’ plan — vouchers to purchase a private insurance plan — may be political kryptonite, and some are starting to back away. So what will the Democrats do to curb costs? The new health-care law gives an independent board the power to make sweeping cuts in Medicare spending. President Obama’s new deficit reduction plan proposes to beef up that power. Republicans and some Democrats want none of it. They claim the Independent Payment Advisory Board usurps Congress’ spending power over a huge and important social program. “It’s our constitutional duty, as members of Congress, to take responsibility for Medicare and not turn decisions over to a board,” said Rep. Allyson Schwartz (D-Pa.), a co-sponsor of a bill to repeal the board. True, Congress is responsible for establishing policies affecting all aspects of Medicare, including payments to health-care providers, hospitals and insurance plans. The problem is that Congress also has a long record of walking away from the most promising attempts to save money in the Medicare program. Congress should not be allowed another opportunity to repeat history. Take bundled payments. In this cost-saving approach, health- care providers receive a fixed sum of money for a package of services, which reduces incentives to overuse services. Many health economists – and even Congress’ own Medicare Payment Advisory Commission – agree that bundled payments show the greatest promise to reduce Medicare spending. In 1991, Congress seemed to agree. It authorized a demonstration project to test the effectiveness of bundled payments for cardiac- bypass surgeries, one of the most common and costly services in Medicare. Four hospitals were chosen for the demonstration, and each was paid a single fee for all inpatient and physician services for heart-bypass patients. The result? Medicare saved more than $50 million over five years — and quality of care improved. Yet the American Hospital Association and organizations like the Mayo Clinic didn’t like the idea. Congress caved in to the pressure, killing any chance of broader implementation. Another promising solution to Medicare’s cost problems involves competitive bidding. Because certain health-care services can be considered as commodities, Medicare could save money by buying them from the lowest-cost supplier. In 2002, Medicare began a demonstration project using competitive bidding when buying such medical equipment as oxygen tanks, diabetes supplies and wheelchairs. The approach produced a 20% savings over a six-year period, according to Medicare. Initially a strong supporter of competitive bidding, Congress again wilted in the face of vigorous opposition from large medical supply companies. The effort remains on hold. There are other areas where money can be saved if Congress would join the cause. The use of diagnostic and imaging services has exploded in recent years. In 1980, 3 million CT scans were done in this country. By 2008, the figure had climbed to 68 million . The rise came despite evidence that CT imaging could be responsible for 1 in 50 future cases of cancer, according to an article in the New England Journal of Medicine. In 2007, Medicare moved to disallow CT imaging for cardiovascular disease in cases where the scan was not clinically warranted. With the backing of Congress, Medicare officials took the risky step of demanding evidence of a scan’s benefit before paying for it. Lobbyists for cardiologists soon arrived on Capitol Hill, and Congress again lost its nerve. The result is that Medicare is helping to subsidize a technology that may be doing extensive harm. Congress can’t even agree to pay more money for better performance. In yet another demonstration project started in 2005, Medicare created a pay-for-performance reimbursement system that rewarded health-care providers who were better at managing their patients. In three years, physician groups and hospitals showed better outcomes on 28 of 32 clinical measures — such as blood pressure, weight and LDL cholesterol levels — for patients with diabetes, congestive heart failure and coronary artery disease. Participating hospitals saw their Medicare quality scores – such as readmission rates — increase by 17% in four years. But not a peep from Congress. The beauty of the Independent Payment Advisory Board is that it keeps Congress on the sidelines. If Medicare spending growth exceeds a set target, the board is required to recommend cuts to reduce spending by specified amounts, starting in 2015. The reductions automatically go into effect unless Congress comes up with alternative cuts that result in equivalent savings. Congress, of course, flinched when it could have enhanced the board’s powers when drawing up the Affordable Care Act. By not giving the board the authority to recommend changes in Medicare benefits, impose cost-sharing on patients or reduce payments to providers and suppliers already scheduled for cutbacks, Congress bypassed yet another opportunity to save money. Medicare is one of the few areas in government where we know what to do to start saving money. Congress’ long history of support for wasteful Medicare spending shows that we can’t trust it to help. Dana P. Goldman is director of the Leonard D. Schaeffer Center for Health Policy and Economics at the University of Southern California. Veeral Shah is a graduate student in the school of public policy.