• How the IPAB dies

    Julian Pecquet of Healthwatch:

    Two House Democrats have signed onto a Republican bill to repeal a health reform provision that the Obama administration has touted as a central tool to keep health costs under control [the Independent Payment Advisory Board, IPAB]. […]

    [C]ongressional Democrats have been under tremendous pressure from doctors and hospitals to try to nix an unelected board that directly threatens their bottom line. Over the years, the current Medicare Payment Advisory Board has seen millions of dollars worth of recommended Medicare cuts ignored by Congress.

    With Democrats reluctant to pick away at their top domestic accomplishment, Republicans have moved in with proposals to repeal unpopular provisions. Rep. Phil Roe (R-Tenn.) introduced legislation to repeal the IPAB at the start of the new Congress; he was joined by Rep. John Fleming (R-La.), a family physician, who called the IPAB a Soviet-style “central planning committee.”

    File under, “why cost control is very hard.” Cross-list under, “how Congress blows it every time.” There really is no cost control solution if something like the IPAB can’t work. Pass any law you like, with any stipulations about capped rates of increase in public spending on health care. What’s to stop Congress from undoing it? Nothing. You can be for the IPAB for cost control reasons, but you can’t be against the IPAB for cost control reasons.

    Can you be against the IPAB for “Soviet-style ‘central planning'” reasons? Well, what form of cost control lacks a capacity to say, “No, we’re not paying for that, but you’re free to pay for it out of your own pocket or buy supplemental insurance for it”?

    • After reading that story, I can’t decide if the appropriate response is laughter or crying. Does anyone, one single person, believe that Congress will control cost? Even the party that claims to love fiscal responsibility swings back and forth between wanting to cut Medicare and decrying any attempt to control those costs as death panels or some other foolishness.

      The only way to actually control health care costs is to have an adult conversation about medicine, its limitations and our finite resources. I’m not holding my breath waiting for that day to come, though.

    • When (my Congressman) Phil Roe spoke to our local TN Academy of Family Physicians chapter last month, he spent a great deal of time making the case that the skyrocketing cost of Medicare was a major contributor to the deficit, and that we needed to reign in Medicare spending. He then spent a good bit of time trashing the IPAB as noted above. I pointed out the apparent contradiction in his arguments and asked what he was proposing in place of the IPAB to control Medicare costs. After making some nonsensical comments about substituting a private system like the Federal Employees Health Benefits Plan he zeroed in on the fact that there is an inordinate amount of Medicare dollars spent on care in the last 12 months of life. He went on to say that we need to do a better job of helping elderly patients and their families opt for less aggressive end of life care when appropriate, I about lost it at that point. I wanted to remind him that that’s what advance directives are all about and to ask if he was really advocating for “death panels”. But (perhaps unfortunately) my cooler head prevailed and we at least broached the issue of health care rationing as something that currently exists and that will, of necessity, be part of the future of health care.