The individual market for health insurance has become so terrible that it was necessary to support the passage of a bill with many aspects as the status quo has become unacceptable. The problems became even worse with the Affordable Care Act when, due to the loss of Ted Kennedy’s Senate seat, it became necessary for Congress to pass the Senate bill instead of the much preferable House bill. I now hope to see many of the bad sections of the act repealed (noting that if the Republicans had wished to cooperate in the process we could have passed a bill without some of these aspects in the first place). So far repeal of the 1099 requirements on small business appears likely. The individual mandate may or may not survive in the courts. The latest portion to justifiably be under attack is Independent Payment Advisory Board with two House Democrats now joining the effort.
In principle the Independent Payment Advisory Board was a good idea, providing a mechanism by which changes in Medicare could be proposed outside of the political process. The problem is that the Senate bill takes this too far, making it virtually impossible for their cost-cutting recommendations to be rejected, regardless of their impact on quality. Medical organizations which did support health care reform, such as the American Medical Association and the American Osteopathic Association, have supported efforts to change this provision of the Affordable Care Act. There must be a balance between cost cutting and preserving quality. While there are benefits to an independent body making suggestions analogous to the military base commissions, the ultimate decisions as to whether to cut costs or concentrate on quality should be made by elective representatives.
One irony here is that I am supporting Republican sponsored legislation here out of fear of Republican influence over health care. I can easily imagine a Republican government packing the board with people who share their desire to eliminate the Medicare program. If this were to happen, they could pass measures which could cut costs to the point where the program could not continue to operate in its current form.
The Republican are doing the right thing in opposing the board, even if probably for the wrong reasons. During the health care reform battle, Republicans such as Sarah Palin initially complained that voluntary end of life counseling meant the initiation of “death panels.” When faced with the absurdity of this argument, especially as many Republicans had previously advocated the same form of end of life counseling, some Republicans later turned to the Independent Payment Advisory Board as a potential death panel. While still ridiculous hyperbole, this argument at least makes more sense than their previous argument.
