IPAB set up to make hard choices Congress dodges

WASHINGTON — Ordinarily, tea party conservatives would be wary of power-grabbing elected politicians making momentous decisions on complicated matters that ought to be the prerogative of the very finest experts the nation can muster. And especially so, when it comes to issues that can affect the healthy lifestyle — and, perhaps even the life — of every American visiting a doctor’s office or checking into a hospital.


That’s why the lawmakers who crafted the Affordable Health Care Act last year created an Independent Payment Advisory Board — 15 presidentially appointed health experts all subject to Senate confirmation — to sift through thousands of potentially unpopular cost-control options and then recommend the most effective to Congress.

That idea makes eminent good sense. After all, who would trust politicians to make politically difficult decisions regarding cost-savings — particularly after watching the daily games of Capitol Hill dodgeball during budget the deficit crisis.

The 24/7 television coverage highlighted both Republican and Democratic congressional leaders uttering pious sermons about the urgent need to lop trillions of dollars from federal programs and then side-stepping the issue as if it were a spitting cobra with a migraine headache. That’s where the Independent Payment Advisory Board comes to the rescue.

Its particular Labor of Hercules is to find a way to curb runaway Medicare costs and still preserve the quality care our nation’s seniors — who paid money into the system for decades — surely deserve. Once the experts decide the most viable ways to make cost-cuts, they must send their recommendations to Congress, which can adopt or else come up with alternatives of its own so long as they match the same spending targets designated by the IPAB.

The non-partisan Congressional Budget Office estimates that the IPAB’s blue-ribbon panel of experts would save taxpayers about $15.5 billion between 2015 and 2019 when the board’s recommendation take effect four years from now. And it predicts savings will balloon upward after that when temporary Medicare reimbursements for hospitals come to an end.

This common-sense approach immediately came under salvos of cannon-fire from the tea party brigades who loaded up with such hackneyed rhetorical shells such as “death panels” and “government rationing.” What they are talking about, of course, is not wheeling poor granny down to the town dump and tipping her onto a mound of garbage, but making those hard, hard choices that conservatives constantly tell us are “necessary” to keep the U.S. in the forefront of civilized nations.

As Pulitzer Prize-winning New York Times columnist Paul Krugman recently noted: “We have to do something about health care costs, which means that we have to find a way to start saying no. In particular, given continuing medical innovation, we can’t maintain a system in which Medicare essentially pays for anything a doctor recommends. And that’s especially true when that blank-check approach is combined with a system that gives doctors and hospitals — who aren’t saints — a strong financial incentive to engage in excessive care.”

At least two Republican lawmakers apparently think Congress has unlimited funds to extend life ad infinitum — piling up hundreds of thousands of dollars to extend a life by a few extra days or weeks. Rep. Phil Roe of Tennessee has introduced a bill to repeal the IPAB section of the health reform act, charging it usurps congressional powers and it would mean-spiritedly compromise quality care. And Sen. John Cornyn of Texas has introduced companion legislation in his chamber.

Other attackers include such vested interests as the American Medical Association — which represents about a third of the nation’s doctors, and PhRMA, the trade association voice of the prescription drug industry. Both would sacrifice a considerable part of their profits if their Medicare reimbursements were pared back.

Instead of shared sacrifice to make the nation’s health-care system work, the Republicans seem intent on giving us the same old shared greed and hypocrisy.

• Madsen is a contributing writer to www.onlinejournal.com.


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