Tuesday, April 26, 2011

The “Imperial” Experts of IPAB — or Why Ronald Reagan Was Right

This weekend a liberal blogger with the American Prospect wrote a post responding to Paul Krugman’s Friday New York Times column on the Independent Payment Advisory Board (IPAB).  The post argues that Congress cannot address policy issues (like how to control health care costs), meaning unelected bureaucrats like those on the IPAB should be granted unfettered power to do so themselves: “Despite many reasons for caution—the words George W Bush foremost among them—I’m becoming more of a believer in an imperial presidency in domestic policy.”  In other words, “imperial” bureaucrats like those on the IPAB should be permitted to enact whatever policies they want unilaterally.

Perhaps not surprisingly given the current debate surrounding the IPAB, liberal intellectual elitism along these lines has surged in recent weeks:

  • The White House’s defense of the IPAB talked about the “experts” who would make decisions on controlling costs in Medicare – and then claimed that “experts” agreed the IPAB was a positive tool for doing so.  (It’s entirely possible that the same “experts” praising the IPAB would be the same “experts” serving on it – meaning the arguments in the post could be viewed as the sound of one hand clapping.)
  • Krugman’s column also talked about a board of “experts” who would be charged with “saying no” to patient treatments – because patients are too feeble-minded to serve as consumers themselves.
  • The Post’s Ezra Klein asserted that “Patients don’t know enough…to say ‘no’ to what a doctor says they need” and argued one of the only ways to reduce costs was to create “systems where doctors and providers have to negotiate with the government” – because a bureaucracy can do a better job of controlling costs (through arbitrary price controls).
  • Former Speaker Pelosi claimed in a speech that “elections shouldn’t matter as much as they do.”

With entitlement reform at the center of a national debate, one of the central questions of the next two years is whether the American people want an “imperial” board of unelected but “expert” bureaucrats making their health care choices – or whether they want to preserve the power to make those decisions themselves.  The Great Communicator said it best:

This is the issue of this election: whether we believe in our capacity for self-government or whether we abandon the American revolution and confess that a little intellectual elite in a far-distant capitol can plan our lives for us better than we can plan them ourselves.