Just the Facts on IPAB
The Center for American Progress has a blog posting about an event it held with Atul Gawande, in which he made comments about the Independent Payment Advisory Board (IPAB) – a body created in the health care law to enforce a cap on Medicare spending (a cap that President Obama’s deficit reduction plan wants to lower even further). Both Dr. Gawande’s comments and the posting itself include misconceptions about the board and its roles and duties:
- Gawande claims that the IPAB will merely issue “rules of the road” to control costs. That’s not accurate – the IPAB is specifically charged with enforcing caps on Medicare spending.
- Gawande discusses one of the “rules” for the IPAB to examine: “Is it okay if in a community the doctors and the hospital become consolidated? And some competition starts to disappear. What happens when that happens?” But the IPAB has no jurisdiction over competition law, or antitrust concerns – its raison d’être is enforcing a cap on Medicare spending.
- The blog post itself claims that “unlike insurers…the IPAB will establish the ‘rules of the road’ in a transparent and accountable manner.” The IPAB may be transparent, but it is definitely NOT accountable – unlike insurers, whom customers can sue for denying covered treatments, the decisions of IPAB’s unelected bureaucrats are not subject to judicial review.
A column in the Fiscal Times last week more accurately describes what the IPAB really is – a board of bureaucrats that will limit coverage options:
Consumers themselves are in no position to make informed decisions about health care, especially with the stress, worry, and need for instant decisions that an illness can present….The solution…is for people with the necessary knowledge about medical services and a commitment to the public interest to do what HMOs did in the 1990s, decide which procedures should and should not be covered by Medicare….Consumers are unlikely to trust any limitations on something as important as their health care from insurance companies or government appointed boards; they certainly didn’t like this part of HMOs. But our long run budget problem is driven mainly by the expectation of rising health care costs, and we have no choice but to find some way of bringing these costs under control. The only question at this point is how these decisions will be determined, and among the feasible choices a board of experts is the best choice that we have.
Some would argue that empowering patients rather than bureaucrats is a much better solution to controlling health care costs. But regardless, the Fiscal Times at least identified the important issues in the ongoing entitlement debate – namely, whether Americans will support having a “board of experts” determining whether or not they receive needed care.