March 22 2012
IPAB: A Lesson in Governing Poorly
Judgment Day is coming for one of the most controversial aspects of ObamaCare.
No, I'm not referring to the Supreme Court hearing on ObamaCare's constitutionality, which will take place next week. The House, possibly today, will vote to repeal the Independent Payment Advisory Board (IPAB), the 15-member board charged with dictating Medicare payments to doctors with the goal of controlling costs.
Medicare direly needs reform, but IPAB is the wrong approach. First, IPAB is antithetical to a democratic government representative of and accountable to the governed. While lawmakers often "delegate" tough tasks to other bodies, IPAB goes beyond typical political decision-punting. This board, comprised of unelected bureaucrats (with no requirement that any of them be physicians), will make recommendations to Congress that automatically become law — unless a supermajority in both houses of Congress opposes them and Congress manages to come up with a replacement plan for the recommended cuts.
As it is, Congress can hardly work together on anything; how can we expect future Congresses to stand up united against this incredibly powerful board? Which is precisely the point. Policymakers don't want responsibility for making Medicare's books balance. IPAB is simply a political tool, intended to shield the cutters from the voters.
But there's a reason our representatives in government are elected: So citizens can hold them accountable. If the IPAB dictates payment schedules that are unworkable, the public will have no recourse. It's no surprise, then, that the Goldwater Institute, a government watchdog group, is challenging IPAB's constitutionality in federal court.
IPAB's real purpose is to provide political cover for ObamaCare. It allows politicians to shift blame for unpopular cuts to a "nonpartisan" group of untouchables while lawmakers take the credit for reducing Medicare's costs. For example, The New York Times editorial board has already fallen for this charade. An editorial titled "We Thought They Were Worried About Costs" ran March 8, criticizing Republicans for opposing IPAB. Yet this critique misrepresents the concerns of IPAB opponents (which include many Democrats as well). Yes, Medicare's dire financial situation needs to be addressed. But not in a way that undermines the political process and harms seniors and their doctors.
Last year, when Paul Ryan debuted his plan to save Medicare, he was demonized by those on the Left for "ending Medicare as we know it," and even depicted in a commercial wheeling Grandma over a cliff.
These unfair characterizations of his plan left out a critical detail: The formula Ryan used in the Path to Prosperity plan was only slightly more aggressive than the IPAB formula for making cuts to Medicare. And the proposed cuts in the Rivlin-Ryan plan would've gone no further than IPAB in making cuts.
The difference with the conservative approach to Medicare reform is the way the cuts are made. Liberals want IPAB officials to gouge Medicare and use the savings to fund other new, unpopular, unnecessary entitlement programs. Conservatives want to fundamentally change the incentives within Medicare, so that individuals, families and the medical community use health care dollars more efficiently.
Some worry IPAB will result in health-care rationing. Others note that the law explicit forbids "rationing." The bottom line is that doctors will react to the cuts in payments by limiting access to certain treatments. Call it what you want — "rationing" or "advising payments" – this will result in the denial of care to some patients.
IPAB defenders argue that "economic rationing already happens" in health care. By this they mean that, in a world of limited resources, people's treatment options are limited by what they can afford or what they choose to buy. If Johnny is sick, he may see a doctor. Or he may "ration" his dollars and not go until his condition is more serious.
The question left to Americans, then, is this: Who will we want "rationing," or controlling, our health care spending in Medicare? A team of technocrats in Washington, D.C.? Or ourselves as individuals?
IPAB is a lesson in how to govern poorly. At its core, IPAB is about political blame-shifting and avoiding a real conversation about how to fundamentally improve Medicare.
IPAB must be repealed now so we can refocus on putting Medicare on the right course and empowering individuals to control over their own health care.