"Death Panel" - Obamacare Controversy - Time Mag Analyst: "Rationing" Board In Law
Posted March 22, 2012
A Walkthrough Of ObamaCare’s Most Powerful Bureaucracy
OBAMACARE ALLOWS FOR UNELECTED BUREAUCRATS TO CONTROL HEALTH CAREObamaCare 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)
IPAB Threatens Patient CareObama’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)
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 ACCOUNTABILITYMembership 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 IPABThe 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 IPABThe 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)
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. 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 BUREAUCRATSThe 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 IPABObama 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 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)
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