Unelected bureaucrats

Jon Cohn defends the Independent Payment Advisory Board while attacking consumer directed health care in a new Kaiser Health News column.

The latest effort [to dismantle health reform] came last week, when a group of Republicans in the Senate proposed abolishing the Independent Payment Advisory Board. …

The IPAB will consist of 15 members, appointed by the White House and confirmed by the Senate, who will serve staggered six-year terms. Starting in 2015, if Medicare spending exceeds targets set in the reform law, the IPAB will recommend changing the way Medicare pays for services, in order to reduce spending. The president and Congress will have the power to reject those recommendations, but only if they come up with equivalent reductions of their own. …

Wait, don’t these Republicans critics want to stop Medicare from growing so fast? And don’t they also want to reduce overall spending on health care? Why, yes they do. But they think IPAB is the wrong way to do it, because it means government–i.e., “unelected bureaucrats”–are the ones who should be deciding how to cut spending. …

[Instead] they say … to let the market reduce spending on its own: Turn Medicare into a voucher program and then expose all Americans, old and young, to significantly larger out-of-pocket expenses. Advocates of this strategy claim that individual consumers will seek out the best deals and that the resulting competition will make the entire health care system provide more care for less money.

First of all, the IPAB could itself recommend more consumer directed approaches in Medicare. (Or is there something in the law that precludes the IPAB from doing so? CDHP advocates/IPAB opponents, speak up!)

Second of all, if the IPAB’s unelected bureaucrats don’t guide Medicare to a more sustainable future, who will? The elected ones! And how well are they doing that job? You know the answer, but just to hammer it home, here are a few graphs, discussed here and here.



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