Quote of the Day

“The Republicans need to come up with a more appealing alternative to Medicare than death.” –Andy Borowitz

Opposition Growing To Medicare Payment Board

At one time we had two competing versions of the health care reform law passed by each house of Congress. The bill from the House of Representatives was much better than the bill from the Senate but, due to the mechanics of getting a bill passed by budget reconciliation after the Democrats lost their 60th Senate seat, we got stuck with the Senate bill instead. One of its faults was the manner in which the Independent Payment Advisory Board in the Senate bill goes too far in being structured towards cutting costs, as opposed to balancing quality and cost, without input from our elected representatives.

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.

It might make sense to obtain recommendations from a board which is independent of politics and then have Congress consider them. I’ve found that many of the liberal bloggers who support the IPAB are under the misconception that the recommendations would be subjected to an up or down vote. This is not the case, which is why a growing number of members of Congress, along with health care organizations, support repeal of the IPAB as currently structured in the Affordable Care Act.

Since my previous post on this subject, Politico now reports that National Committee to Preserve Social Security and Medicare, a prominent supporter of the Affordable Care Act, has joined in the opposition to the IPAB.

“IPAB turns Medicare into a scapegoat,” said Max Richtman, executive vice president and acting CEO of the National Committee to Preserve Social Security and Medicare. “Medicare will be forced to make reductions without addressing the rest of the health care costs.”

The group also is concerned that it would be hard for Congress to overturn any decisions by the board; it would have to come up with an equal amount of savings to stop the board’s decisions.

It’s a concern echoed by lawmakers, who are most likely to face the political fallout for the board’s actions.

“Abdicating this responsibility, whether to insurance companies or an unelected commission, would undermine our ability to represent the needs of the seniors and disabled in our communities,” Rep. Allyson Schwartz (D-Pa.), a prominent supporter of most of the reform law, wrote in a letter to colleagues in April.

Currently seven Congressional Democrats have joined in sponsoring a bill to eliminate the IPAB, with other Democrats indicating they would vote for the bill if it makes it to the floor of the House. It will be more difficult for repeal to pass in the Senate:

Gathering support among Democrats will be easier in the House than in the Senate, where the idea began. The House health care bill didn’t include the IPAB, and several dozen members expressed their opposition to the board to then-Speaker Nancy Pelosi.

The National Committee says it is talking with lawmakers about its concerns about the IPAB.

“We’ll be meeting with members, trying to persuade them that they need to be responsible, and the responsible thing to do is to scrap that and take on Medicare costs through the regular committee process,” Richtman said.

Health care provider groups have made IPAB repeal a top priority, too. If they can’t repeal the whole provision, they want to eliminate a deal made last year to keep hospitals out of the program until 2018.

“We’re going to raise holy hell if IPAB happens without the hospitals,” a health lobbyist said.

It is also likely that many Democrats and liberal groups will oppose Republican-led efforts to repeal the IPAB, seeing this as part of the overall efforts of Republicans to repeal health care reform.

If the Republicans really do oppose this out of principle, this is an example where their strategy failed in outright opposing any form of health care reform. If Republicans had participated in the process, they could have received compromises, including less power for the IPAB, malpractice reform, and keeping the 1099 requirements (which have been successfully repealed) out of the final law.