Opposition To The Senate Version Of The Medicare Independent Payment Advisory Board

As I have also noted here previously, The New York Times reports on some Democrats joining Republicans in opposing  Independent Payment Advisory Board which would be able to require cuts in Medicare. The way the IPAB is structured it will be difficult for Congress or the White House to overrule their demands.  I have seen differences in opinion as to the degree to which Congress might be able to circumvent reductions in care with measures such as restoring unpopular cuts through independent legislation.

The commentary on this is generally split by the usual left versus right divide. Many liberal blogs point out the hypocrisy of Republicans who complain about government spending while opposing measures which will help to reduce spending. Republican claims that the IPAB would be a “death panel” are absurd. There is no question Republicans are being hypocritical and frequently outright deceitful in almost everything they say about the Affordable Care Act. Despite this they are right in opposing the IPAB in the form present in the original Senate bill. (They are wrong in opposing any type of advisory board). Many Democrats also prefer a version closer to what was origianlly passed by the House.

We do need to try to separate politics from Medicare policy to allow for sensible cuts, but the IPAB as now planned goes too far in being structured towards cutting costs as opposed to balancing quality and cost.

There are many tough decisions to be made with regards to Medicare. Cutting costs must be considered, but with an aging population and costly but worthwhile advances in medical technology we must balance cutting costs with what we want out of the health care system.  At times the best decision might be to maintain current levels of spending, or perhaps even to spend more as opposed to cutting costs. A board designed primarily to cut costs will not necessarily make the decisions we desire.

Many of the liberals supporting the IPAB do not even understand what the legislation calls for. For example, Think Progress defends the IPAB by saying:

…I would argue that it’s far better to have representatives of the various stakeholders in health care — drug companies, hospitals, doctors, patients — (all of whom are nominated by the president and confirmed by the Senate) making these decisions in a transparent, public, and accountable manner and then submitting their plan to Congress for a vote…

The problem is that there is no simple up or down vote by Congress. In order to override the recommendations a three-fifths vote would be required, which is rarely possible to achieve. The IPAB is structured to reduce spending at levels which very well might exceed that desired by most Americans and members of Congress.

We should have politically independent groups to make recommendations but the final decision on such matters should be made by elective representatives who are responsible to the voters. Besides, do we really want to risk the outcome if Republicans retake control of the government and pack the IPAB with the type of people who think Medicare should be replaced by a voucher plan?

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