There is no question that Medicare must be improved to provide better health benefits to seniors at lower costs. But Congress is abdicating its constitutional responsibility by giving a panel of 15 unelected technocrats the power to cut Medicare spending and make decisions which will only result in rationing of care.
The Independent Payment Advisory Board was created as part of the new health law to guarantee that Medicare stays within a strict budget. The IPAB received little attention before the law passed, but opposition is growing inside and outside Congress.
IPAB stands for everything that is wrong with ObamaCare — taking power away from doctors and patients and putting it in the hands of elite experts who have virtually no accountability to patients or voters.
Rep. Frank Pallone (D-NJ), the top Democrat on the Energy and Commerce Health Subcommittee which oversees Medicare, said he has no interest in defending the board. “I’ve never supported it, and I would certainly be in favor of abolishing it,” he said.
At least five Democrats have joined Rep. Allyson Schwartz (D-PA) in cosponsoring legislation introduced by Rep. Phil Roe (R-TN) to repeal the IPAB. “Congress is a representative body and must assume responsibility for legislating sound health care policy for Medicare beneficiaries, including those policies related to payment systems,” Schwartz said.
Even the Obama administration is offering a weak defense. Healte, Education and Welfare Secretary Kathleen Sebelius was recently called before two House committees investigating the board. She insisted the IPAB is simply a “backstop” that shouldn’t be needed if Congress does its job in keeping Medicare spending under control. Then she went on the attack against Republicans, criticizing their plans for Medicare reform — which would start in 2022.
This is an audacious position since Sebelius is presiding over ObamaCare, which takes $575 billion out of Medicare — starting now — to create two shockingly expensive new entitlement programs and creates the all-powerful IPAB whose rulings will quickly dry up access to care for seniors.
The government approach to holding down Medicare spending traditionally defaults to making deeper and deeper reductions in payment rates to providers rather than implementing reforms which reward innovation. The IPAB is true to form. Despite claims from its supporters that the board could encourage innovation, it must meet short-term budget targets and its primary tool will be cutting payments to providers.
The decisions of this unelected, stand-alone board will be virtually untouchable by Congress or the courts. Unless Congress can muster super-majority votes to come up with its own cuts to reach the same targets, the board’s dictates will carry the force of law. No judicial review of the IPAB’s decisions is allowed — a highly controversial rule that is contrary to the constitution’s system of checks and balances in government.
Even before the board’s cuts begin, Medicare is on track to pay doctors and hospitals so little that it will lead to “severe problems with beneficiary access to care,” according to Medicare actuaries.
And President Obama wants to double-down on IPAB’s powers, giving the board authority to cut payments to doctors even more deeply and giving the board power to “sequester” congressional appropriations if Congress tries to overrule its cuts.
The IPAB will be charged with cutting payments even further than ObamaCare already does to reach ever-declining statutory spending targets. It will be sitting at the controls in Washington making decisions which could impact hundreds of billions of dollars in spending and directly impact whether patients will have access to care.
The IPAB clearly is not the right solution to holding down Medicare cost. Instead, Congress must accept responsibility and institute policies that will allow innovation, competition, and beneficiary choice to modernize Medicare and improve it for a new generation of seniors.
Published in the Canada Free Press, August 4, 2011.