Recommendations made by the newly formed deficit commission include limiting Medicare spending, reducing payments to pharmaceutical companies and a more powerful health care costs control board. The proposals set forth in a draft produced by the presidential commission call for higher rebates to be paid by pharmaceuticals to the government and lower payments to be made to doctors. Finally, Medicare beneficiaries would be asked to contribute more toward their care.

The proposals, which are anticipated to be unpopular with the health care industry and seniors, project a $4 trillion reduction in deficit spending through 2020. The commission’s final report is expected Dec. 1.

The Independent Payment Advisory Board, a health care costs control board created by the health care reform law, would be given greater powers to dampen down Medicare costs in the event Congress fails to do so. The Pharmaceutical Research and Manufacturers of America trade group is working hard to eliminate the panel before it can begin work in 2015.

Commission co-chairs Erskine Bowles and Alan Simpson also urged an acceleration of the payment cuts to Medicare Advantage providers as well as a reform of medical malpractice rules, which would help reduce “defensive medicine,” something Republicans have long sought.