• Meme Roundup: IPAB as Similar to Republican-Suggested Boards

    I am pulling together several related posts that I have done suggesting that the Independent Payment Advisory Board (IPAB) is similar to two boards proposed in Title VIII of the Patients’ Choice Act (PCA), the most comprehensive Republican health reform plan offered in the 111th Congress. That doesn’t mean they are exactly the same, but does mean that some of the criticism levelled against IPAB by Republican critics is either uninformed about the advocacy for such boards by leading Republicans in the past, or seems hypocritical to me. It is also possible that Republicans have simply changed their mind, but then I would expect them to say that, and to lay out why they recently supported such boards, but no longer do so.

    Both the PCA and the ACA proposed boards that were insulated in some manner from Congress to make health policy decisions. In this way, IPAB is a prime example of a policy idea that ended up in the Affordable Care Act (ACA) that had its genesis in a Republican sponsored bill, or line of policy thought. It is an example of something that appeared to be bipartisan in policy terms (the need for boards insulated from Congress) that became politically toxic once it appeared in the ACA.

    Here are the posts I have written on the topic.

    • General argument that IPAB is similar to the boards suggested in the PCA, from May, 2011.
    • Responding to unelected bureaucrats/unconstitutional charges by showing that boards proposed in PCA were similar in structure, Monday July 11.
    • Focus on what IPAB could do in policy terms as compared to what boards in PCA were proposed to be able to do, Tuesday July 12.
    • Reaction from House Budget Committee spokesman to my blogging, and my response, Tuesday July 12.
    • ThinkProgress did a nice table comparing IPAB to boards in the PCA, Wednesday July 13.

    Other relevant information.

    • Text of the Patients’ Choice Act, Title VIII p. 206-215 are the portions relevant to this discussion. Introduced on May 20, 2009 and co-sponsored by Ryan and Nunes in House; Burr and Coburn in Senate.
    • Text of the ACA, sec. 3403 p. 982-1,033 lays out the IPAB
    • Kaiser has a comprehensive overview of the IPAB
    • Column I wrote on July 24, 2009 in the Raleigh, N.C. News and Observer on the Patients’ Choice Act

    Note: as stated in several posts, there are some Democrats who oppose IPAB as well.


    • Republicans supported an individual mandate for about two decades. Bills sponsored by Bob Dole, Richard Lugar, Chuck Grassley, Orrin Hatch, Jesse Helms, Trent Lott, and others all featured one. In the summer of 2009, Grassley, then a lead GOP health insurance reform negotiator, said that there was a “bipartisan consensus” in favor of the individual mandate, because “Republicans believe in individual responsibility.”

      Then the Democrats agreed with him, and proposed an individual mandate. Grassley, and most of the rest of the GOP, then said it was unconstitutional.

      Paul Ryan opposed the ACA in part because, he said, Obama broke his “promises” by cutting Medicare. He wrote an op-ed claiming, “hundreds of billions of dollars will be cut from Medicare.” He repeatedly made this complaint in other venues.

      When he proposed his voucherization of Medicare plan earlier this year, he maintained the savings passed in the ACA.

      I think it is deeply unfair to suggest that the behavior of Republicans “seems hypocritical.” That implies that they have principles.