"Death Panel" - Obamacare Controversy - Time Mag Analyst: "Rationing" Board In Law
Canada's Supreme Court has ruled that under the "law of the land" in
Ontario, a government board, not the family or doctors, has the ultimate
power to pull the plug on a patient.
Lost in the discussion of defunding ObamaCare and the failed effort
in Congress is the fact that failure means the government's ability to
defund your life through the ObamaCare's Independent Payment Advisory
Board (IPAB) remains. IPAB is regarded by many, starting with former
Alaska Gov. Sarah Palin, as a death panel whose decisions based on cost
effectiveness would result in health care rationing.
A glimpse of this brave new world can be had by casting a glance at
our neighbor to the north. There, Canada's Supreme Court ruled 5-2 that
under Ontario's Health Care Consent Act, which has been on the books for
nearly two decades, doctors cannot overrule a family's wishes for an
incapacitated patient regarding life or death decisions, but an
administrative tribunal can.
A Walkthrough Of ObamaCare’s Most Powerful Bureaucracy
OBAMACARE ALLOWS FOR UNELECTED BUREAUCRATS TO CONTROL HEALTH CARE
ObamaCare Created The Independent Payment Advisory Board
(IPAB) “To Come Up With Ways To Cut Medicare Spending If It Grows Too
Fast.” “That’s the job description for the 15 members of the
Independent Payment Advisory Board — the new panel created by President
Barack Obama’s health care law to come up with ways to cut Medicare
spending if it grows too fast.” (David Nather, “Medicare Cost-Cutting
Job Could Be Worst in D.C.,”
Politico, 5/14/11)
- “If Per Capita Costs Grow By More Than GDP Plus 0.5%, This
Board Would Get More Power, Including An Automatic Budget Sequester To
Enforce Its Rulings” To Cut Medicare Costs. “Fifteen members
will serve on the Independent Payment Advisory Board, all appointed by
the President and confirmed by the Senate. If per capita costs grow by
more than GDP plus 0.5%, this board would get more power, including an automatic budget sequester to
enforce its rulings. So 15 sages sitting in a room with the power of
the purse will evidently find ways to control Medicare spending that no
one has ever thought of before and that supposedly won’t harm seniors’
care, even as the largest cohort of the baby boom generation retires and
starts to collect benefits.” (Editorial Board, “The Presidential
Divider,” The Wall Street Journal, 4/14/2011)
The Wall Street Journal: IPAB Embraces The Thought That Health Care Decisions Are Best Made By Bureaucrats Rather Than Patients. “This
turn is remarkable because the IPAB really does embody ObamaCare’s
innermost values and beliefs—to wit, that health decisions are too
important to leave to the people receiving the care (patients), the
people providing the care (doctors and hospitals), the people paying for
the care (taxpayers), or even the people who got the government
involved in the first place (politicians).” (Editorial, “Independent
Payment Advisory Revolt,”
The Wall Street Journal, 3/9/12)
IPAB Threatens Patient Care
Obama’s HHS Secretary Admits That IPAB Threatens Seniors’ Access To Certain Procedures. “‘If
Congress accepted the recommendations and made the decision that cuts
in dialysis were appropriate,’ Sebelius replied, ‘I assume there could
be some providers who would decide that would not be a service they
would any longer deliver…’” (Kathleen Sebelius, “IPAB: The
Controversial Consequences For Medicare And Seniors,” House Energy And
Commerce Committee’s Health Subcommittee, 7/13/11)
Witnesses At A Recent Congressional Hearing Argued That IPAB Would Reduce Access To Medical Care. “The
Independent Payment Advisory Board, created under the health care law
to help control Medicare costs, lacks flexibility to do much more than
cut provider payments that would lead to a reduction in access to care,
witnesses told a House Ways and Means panel March 6.” (Ralph Lindeman,
“IPAB Would Reduce Access to Care, Witnesses Tell Ways and Means
Panel,”
Bloomberg, 3/7/12)
The Wall Street Journal: IPAB’s “End Game” Will Limit Patient Care.” “The
only alternative, and the IPAB’s true end game, is harsher and more
arbitrary price controls and eventually limits on the care patients are
allowed to receive. The New England Journalists (of Medicine) deny this
reality because ObamaCare has a clause that prohibits ‘rationing,’ even
as the law leaves that term undefined. But reducing treatment options
will be inevitable as government costs explode.” (Editorial,
“Independent Payment Advisory Revolt,”
The Wall Street Journal, 3/9/12)
- The Wall Street Journal: IPAB Will Allow Bureaucrats To “Throw Granny Over The Cliff.”
“One place to start is by attacking the Democratic plan to cut Medicare
via political rationing. Mr. Ryan’s budget had the virtue of
embarrassing President Obama’s spend-more initial budget, and the White
House responded by proposing to increase the power of the new
Independent Payment Advisory Board (IPAB) to decide what, and how much,
Medicare will pay for. The ObamaCare bill goes to great lengths to
shelter this 15-member, unelected board from Congressional review, with
the goal of letting these bureaucrats throw granny over the cliff if
Medicare isn’t reformed. Yet few Americans know anything about IPAB or
its rationing intentions.” (Editorial, “The GOP’s New York Spanking,” The Wall Street Journal, 5/26/11)
Industry Groups Worry That IPAB’s Actions Will Result In “Rationing.” “While
the board is not supposed to be able to cut benefits, industry groups
fear that its actions would result in rationing care. The board … could
cut payments to health care providers.” (Duff Wilson, “Industry Aims At
Medicare Board,”
The New York Times’ “
Prescription,” 11/4/10)
Paul Howard And Douglas Holtz-Eakin: IPAB Is “Fatally Flawed,” Spurns Innovation, And Will “Threaten Seniors’ Access To Care.” “IPAB
is fatally flawed, structured to punish innovative health care
providers and threaten seniors’ access to care while leaving the
largest sources of Medicare spending untouched. It continues
Washington’s obsession with price-fixing in Medicare’s separate ‘silos’
rather than changing the incentives that have led to rampant
overspending, fraud and uneven care quality.” (Paul Howard & Douglas
Holtz-Eakin, Op-Ed, “Repeal And Replace IPAB,”
Politico, 7/12/11)
IPAB BUREAUCRATS WILL HAVE NO ACCOUNTABILITY
Membership To The IPAB Is Not Limited To Health Care Professionals. “The
Act requires the appointed membership of the IPAB to include
individuals who enjoy ‘national recognition’ in several stated aspects
of health policy, including health finance and economics, and further
stipulates occupations which should be represented on the Board
including physicians and ‘experts in pharmaco-economics.’ The Act
specifies that the appointed IPAB members have broad geographic
representation and that the Board be balanced between urban and rural
representatives. In order to preclude conflicts of interest, the Act
stipulates that a majority of the appointed members of the IPAB are not
be persons ‘directly involved’ in the provision or management of the
delivery of items and services covered by Medicare.” (Congressional
Research Service,
Memo To Senator Coburn, 3/18/11)
ObamaCare Gives Obama The Power To Appoint Members To IPAB During Recess. “Because
the President’s recess appointment authority is unqualified, it appears
that he could fill member positions on the IPAB by recess appointment
during any period when he could otherwise make such appointments. Under
certain circumstances, such appointments might be subject to pay
restrictions, but the analysis of such a possibility is beyond the scope
of this memorandum.” (Congressional Research Service,
Memo To Senator Coburn, 3/18/11)
The American Medical Association Opposes IPAB On The Ground That The Board Has Little “Accountability.” “The
AMA has consistently expressed its opposition to the IPAB on several
grounds. The IPAB puts important health care payment and policy
decisions in the hands of an independent body that has far too little
accountability.” (James L. Madara, American Medical Association CEO,
Letter To Representatives Joe Pitts, 2/27/12)
NEARLY ALL HEALTH CARE GROUPS CONTINUE TO OPPOSE IPAB
The American Medical Association Supports Repeal Of IPAB. “On
behalf of the physician and medical student members of the American
Medical Association (AMA), I am writing to express our strong support
for H.R. 452, which was introduced by Representative Phil Roe, and would
repeal the Independent Payment Advisory Board (IPAB). Accordingly, we
strongly support the advancement of this important legislation through
the Energy and Commerce Committee.” (James L. Madara, American Medical
Association CEO,
Letter To Representatives Joe Pitts, 2/27/12)
- Nearly Every Segment Of The Health Care Industry Opposes IPAB. “An
independent panel authorized by President Barack Obama’s health care
law to control excessive Medicare costs increases is drawing heavy fire
from Republicans. Nearly every health industry lobbying group is
pushing for its repeal, as are some consumer advocates. GOP lawmakers
call it a rationing panel, and at least one has suggested seniors will
die from its decisions.” (Ricardo Alonso-Zaldivar, “Accusations Fly Over
Obscure Medicare Board,” The Associated Press, 7/18/11)
- The IPAB Is So Unpopular That 270 Health Care Groups Support Repeal. “All
told, some 270 stakeholder groups signed a letter to members of
Congress urging them to repeal the Independent Payment Advisory Board.
The IPAB is a panel of experts, appointed by the president, that will
have the power to cut Medicare payments.” (Sam Baker, 270 Health Care
Groups Back IPAB Repeal,” The Hill’s “Health Watch,” 6/24/11)
EVEN OBAMA’S ALLIES SUPPORT REPEAL OF IPAB
The Tampa Tribune: “There Is Bipartisan Consensus … That IPAB Is A Mistake.” “There
is bipartisan consensus on Capitol Hill that IPAB is a mistake.
Physicians groups don’t like it, hospital lobbies don’t like it, and
even the American Medical Association, whose support helped pass
ObamaCare into law, has called for its repeal. Some Democrats, including
U.S. Rep. Kathy Castor of Tampa, have signed on to Tennessee Republican
U.S. Rep. Phil Roe’s repeal bill.” (Editorial, “Return Control To The
Patient,”
The Tampa Tribune, 10/15/11)
Twenty Democrats Have Co-Sponsored Legislation To Repeal IPAB. (H.R. 452, Introduced 1/26/11)
- Both Democrats And Republicans Agree That IPAB “Could Arbitrarily Cut Services To Medicare Patients And Payments To Providers.” “But
some Democrats, as well as most Republicans and health care providers
argue the panel could arbitrarily cut services to Medicare patients and
payments to providers with little congressional oversight.” (Jennifer
Haberkorn, “Democrats Split On Independent Payment Advisory Board,” Politico, 7/10/11)
Both The House Ways And Means And The House Energy And
Commerce Committees Passed IPAB Repeal Legislation With Unanimous
Bipartisan Support. “A second House committee agreed by voice
vote Thursday to repeal a key cost-cutting board in President Obama’s
healthcare law. The Ways and Means Committee voted to repeal the
Independent Payment Advisory Board (IPAB), a 15-member panel tasked with
cutting Medicare payments. The Energy and Commerce Committee passed the
same repeal bill earlier this week.” (Sam Baker, “Second House Panel
Clears Bill To Repeal Medicare Board,”
The Hill’s “
Health Watch,” 3/8/12)
Rep. Pete Stark, (D-CA): Setting Low Payment Rates “Could Endanger Patient Care.” “But,
in its effort to limit the growth of Medicare spending, the board is
likely to set inadequate payment rates for health care providers, which
could endanger patient care.” (Robert Pear, “Obama Panel to Curb
Medicare Finds Foes In Both Parties,”
The New York Times, 5/19/11)
- Rep. Pete Stark (D-CA): IPAB Is A “Mindless Rate Cutting
Machine … That Will Endanger The Health Of America’s Seniors And People
With Disabilities.” “I oppose the inclusion the Independent
Payment Advisory Commission, called IPAB. Some of my colleagues support
this Commission because it shields them from having to take tough votes
when it comes to cutting Medicare provider payments. It’s my experience
that Congress always does what is needed to protect and strengthen the
Medicare program. IPAB is a dangerous provision. By statute, this
Commission would be required to hold Medicare spending to an arbitrary
and unrealistic growth rate. It is a mindless-rate cutting machine that
sets the program up for unsustainable cuts. That will endanger the
health of America’s seniors and people with disabilities. It is an
unprecedented abrogation of Congressional authority to an unelected,
unaccountable body of so-called experts. I intend to work tirelessly to
mitigate the damage that will be caused by IPAB.” (“Statement of
Congressman Pete Stark Supporting Health Care Reform,” Office of Rep. Pete Stark, 3/21/10)
Rep. Allyson Schwartz (D-PA) Says IPAB “Could Lead To Arbitrary Cuts To Doctors, Hospitals And Other Providers.” “In
fact, Schwartz will be one of the GOP’s star witnesses at the Energy
and Commerce Committee hearing. She says IPAB puts Congress’s
responsibility in the hands of an outside panel and could lead to
arbitrary cuts to doctors, hospitals and other providers.” (Jennifer
Haberkorn, “Democrats Split On Independent Payment Advisory Board,”
Politico, 7/10/11)
Rep. Frank Pallone (D-NJ) Says He Strongly Opposes IPAB And It Must Be Stopped. “I
am very strongly opposed to the Independent Payment Advisory Board, or
IPAB, created under the Affordable Care Act. I’ve never supported it and
I would certainly be in favor of abolishing it…It’s not the job of an
independent commission to get involved in congressional matters, in this
instance, healthcare policies for Medicare beneficiaries…It’s about a
growing, imperialistic presidency…We have to stop it. We have to reverse
it. We can’t be a part of an effort to let that continue.” (Committee
On Energy And Commerce, U.S. House,
Hearing, 7/13/11)
Rep. Lois Capps (D-CA) “Favors Getting Rid” Of IPAB But Voted Against Repeal Due To No Alternatives Being Offered. “And
Rep. Lois Capps (D-Calif.) said she favors getting rid of the board but
wouldn’t because the repeal bill offered no alternative for controlling
Medicare costs and wasn’t paid for.” (Julian Pecquet, “House Panel
Repeals Health Law’s Cost-Cutting Board With Bipartisan Support,”
The Hill’s “
Health Watch,” 2/29/12)
Former Democrat House Majority Leader Dick Gephardt: IPAB’s Cuts Will Cause “Devastating Consequences.” “It
will propose cuts to Medicare that Congress can override only with
supermajority votes, an unnecessarily high and unrealistic bar. Just as
important, these cuts are likely to have devastating consequences for
the seniors and disabled Americans who are Medicare’s beneficiaries
because, while technically forbidden from rationing care, the Board will
be able to set payment rates for some treatments so low that no doctor
or hospital or other healthcare professional would provide them.” (Dick
Gephardt, Op-Ed, “Medicare Must Remain A Responsibility Of Congress,”
Huffington Post, 6/21/11)
YET THE WHITE HOUSE CONTINUES TO SUPPORT ITS BOARD OF BUREAUCRATS
The White House: “H.R. 5 would repeal and dismantle
the IPAB even before it has a chance to work. … The Administration
strongly opposes legislation that attempts to erode the important
provisions of the Affordable Care Act. … If the President is presented
with H.R. 5, his senior advisors would recommend that he veto the bill.”
(Statement Of Administration Policy,
H.R. 5 – Protecting Access To Health Care Act, Executive Office Of The President, 3/20/12)
Which Is Not Surprising Since Obama Has Recently Called For Strengthening IPAB
Obama Has Continually Pushed For Strengthening IPAB Through His Deficit Reduction Plan. “The
plan calls for strengthening a controversial piece of the healthcare
reform law, and it includes proposals state governments have strongly
opposed. It also would require seniors to pay more for certain Medicare
benefits, according to a summary of the proposal, which would cut $248
billion in Medicare funding and $73 billion to Medicaid and other health
programs.” (Sam Baker, “Obama Health Cuts To Spark Fights With States,
GOP, Industry Groups,”
The Hill’s “
Health Watch,” 9/19/11)
- IPAB Will “Kick In” Earlier According To Obama’s Deficit Reduction Plan. “The
plan proposes strengthening the Independent Payment Advisory Board
(IPAB) — a cost-cutting panel created by healthcare reform that
Republicans have said will ‘ration’ care. Obama’s proposal would allow
the IPAB to kick in earlier.” (Sam Baker, “Obama Health Cuts To Spark
Fights With States, GOP, Industry Groups,” The Hill’s “Health Watch,” 9/19/11)
Obama’s 2013 Budget: “Strengthen the Independent Payment
Advisory Board (IPAB) to Reduce Long-Term Drivers of Medicare Cost
Growth.” (
OMB, 2/13/12)
- Obama’s Budget Lowers The Threshold For IPAB To Make Payment
Changes To Medicare And Provides IPAB With “Additional Tools” To
Control Spending. “To further moderate the rate of Medicare
growth, this proposal would lower the target rate from the GDP per
capita growth rate plus 1 percent to plus 0.5 percent. Additionally, the
proposal would give IPAB additional tools like the ability to consider
value-based benefit design.” (OMB, 2/13/12)
SOURCE:
GOP
Howard Dean wrote in the Wall Street Journal
that ObamaCare’s IPAB needs to be “removed.” He explains why in terms
that will be familiar to those of us who have opposed the ObamaCare Tax
nightmare from the beginning:
One major problem is the so-called Independent Payment
Advisory Board. The IPAB is essentially a health-care rationing body. By
setting doctor reimbursement rates for Medicare and determining which
procedures and drugs will be covered and at what price, the IPAB will be
able to stop certain treatments its members do not favor by simply
setting rates to levels where no doctor or hospital will perform them.
There does have to be control of costs in our health-care system.
However, rate setting—the essential mechanism of the IPAB—has a 40-year
track record of failure.
What ends up happening in these schemes (which
many states including my home state of Vermont have implemented with
virtually no long-term effect on costs) is that patients and physicians
get aggravated because bureaucrats in either the private or public
sector are making medical decisions without knowing the patients. Most
important, once again, these kinds of schemes do not control costs. The
medical system simply becomes more bureaucratic.
The nonpartisan Congressional Budget Office has indicated that the
IPAB, in its current form, won’t save a single dime before 2021. As
everyone in Washington knows, but less frequently admits, CBO
projections of any kind—past five years or so—are really just
speculation. I believe the IPAB will never control costs based on the
long record of previous attempts in many of the states, including my own
state of Vermont.
If Medicare is to have a secure
future, we have to move away from fee-for-service medicine, which is all
about incentives to spend more, and has no incentives in the system to
keep patients healthy. The IPAB has no possibility of helping to solve
this major problem and will almost certainly make the system more
bureaucratic and therefore drive up administrative costs.
To date, 22 Democrats have joined
Republicans in the House and Senate in support of legislation to do away
with the IPAB. Yet because of the extraordinary partisanship on Capitol
Hill and Republican threats to defund the law through the
appropriations process, it is unlikely that any change in the Affordable
Care Act will take place soon.
The IPAB will cause frustration to providers and patients alike, and
it will fail to control costs. When, and if, the atmosphere on Capitol
Hill improves and leadership becomes interested again in addressing real
problems instead of posturing, getting rid of the IPAB is something
Democrats and Republicans ought to agree on.
The IPAB is “essentially a health-care rationing body”? You don’t
say! Back when Sarah Palin was warning about health-care rationing and
death panels (what the IPAB essentially is because that’s what
health-care rationing essentially is), Dean said such accusations were “
made up”
because, apparently, you can’t have a death panel without reference to
“euthanasia” or something “like” it. Now, suddenly, you can have
health-care rationing without direct reference to rationing. Or
something.
He’s arguing that rate-setting itself is doomed to failure, and
that’s quite an admission from a big bigger biggest government pol like
Dean, though I don’t think we can expect him to admit that the same
principle he outlines here actually applies in other areas, as well.
He’s certainly not suddenly becoming an advocate for the free market.
But he’s finally got it right: the IPAB
is essentially a
health-care rationing body, and we should all be able to agree that
there is nothing good — no improved health care, no decreased costs —
that can come of it.
SOURCE: Legal Insurrection