IPAB suddenly under the spotlight

posted at 9:36 am on April 20, 2011 by Ed Morrissey

In his speech last week, Barack Obama pledged to curtail health-care spending by giving more power to the Independent Physicians Advisory Board (IPAB), an unelected 15-member panel appointed by the President.  Opponents of ObamaCare have had their sights fixed on the IPAB as a care-rationing board since the summer of 2009, while the media and many politicians in Congress downplayed their power.  With Obama’s pledge, though, it’s suddenly cool in Washington to take a second look at the IPAB (via Stanley Kurtz at The Corner):

Democrats and Republicans are joining to oppose one of the most important features of President Obama’s new deficit reduction plan, a powerful independent board that could make sweeping cuts in the growth of Medicare spending.

Mr. Obama wants to expand the power of the 15-member panel, which was created by the new health care law, to rein in Medicare costs.

But not only do Republicans and some Democrats oppose increasing the power of the board, they also want to eliminate it altogether. Opponents fear that the panel, known as the Independent Payment Advisory Board, would usurp Congressional spending power over one of the government’s most important and expensive social programs.

Under the law, spending cuts recommended by the presidentially appointed panel would take effect automatically unless Congress voted to block or change them. In general, federal courts could not review actions to carry out the board’s recommendations. The impact of the board’s decisions could be magnified because private insurers often use Medicare rates as a guide or a benchmark in paying doctors, hospitals and other providers.

Even without the “death panels” connotation, this arrangement should offend anyone who believes in accountable government.  The Constitution provides checks and balances between the legislative, executive, and judicial branches, but provides Congress with most of those checks due to its nature as the “people’s branch” of government.  Placing an unelected panel in charge of spending decisions that Congress only can veto — and doing that through the executive branch rather than the legislative branch — offends the very nature of separation of powers.  The Constitution gives Congress the power of the purse, not the President, and the IPAB turns that on its head.

Furthermore, Obama’s promise does push the IPAB further into “death panel” territory because of the nature of its mandate.  It’s not an Independent Accountant Advisory Board, looking for bad fiscal practices to clean up.  The IPAB exists to determine what kind of health services Medicare should and should not provide as a way to save money.  That inevitably means that significant numbers of people on Medicare won’t get the care they desire, and thanks to the single-payer system and the fact that the government has already taken the money for those premiums, most of those will have little choice but to suffer more and die more quickly as a result.  Obama’s pledge to strengthen their power to make those cuts makes the issue even more urgent.

Obama blasted Paul Ryan’s plan to transform Medicare into a voucher plan as somehow un-American, but at least Ryan’s plan would allow seniors to find other insurance if coverage for their care got denied.  Even liberal Rep. Pete Stark sees the difference:

In some ways, Mr. Stark said, expanding the power of the board could be as bad as giving vouchers to Medicare beneficiaries to buy private insurance. “In theory at least, you could set the vouchers at an adequate level,” he said. “But, in its effort to limit the growth of Medicare spending, the board is likely to set inadequate payment rates for health care providers, which could endanger patient care.”

And that’s exactly what the Wall Street Journal sees, too:

Mr. Ryan has been lambasted for linking his “premium support” Medicare subsidies to inflation, not the rate of health cost growth. But if that’s as unrealistic as the liberal wise men claim, then Mr. Obama’s goals are even more so. Medicare grew 2.1 percentage points faster between 1985 and 2009 than Mr. Obama’s new GDP target. At least Mr. Ryan is proposing a workable model for bringing costs down over time by changing incentives.

Mr. Obama, by contrast, is relying on the so far unidentified technocratic reforms of 15 so far unidentified geniuses who are supposed to give up medical practice or academic research for the privilege of a government salary. Since the board is not allowed by law to restrict treatments, ask seniors to pay more, or raise taxes or the retirement age, it can mean only one thing: arbitrarily paying less for the services seniors receive, via fiat pricing.

Post-ObamaCare, Medicare’s administered fee schedule is set eventually to dip below Medicaid payments in many states, which are themselves already far lower than the rates of private insurers that reflect the true costs of health care. Medicare itself says these cuts will cause 15% of U.S. hospitals to become unprofitable in the next decade. Mr. Obama wants Americans to believe that his planners will wring out even more spending through the power of positive technocratic thinking.

So the question is this.  Do we trust seniors with the decisions for their own care, or do we trust hundreds of millions of those decisions each year to 15 unelected, unassailable bureaucrats in Washington DC?  Obama may have made a very large mistake in reopening this political Pandora’s Box in a thoroughly ill-advised speech.


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You can chip away at the edges of health care costs (efficiency, tort reform, etc), but there are only two big picture ways to slow its rate of growth.

1) Increase competition
2) Limit what is covered or provided

BadgerHawk on April 20, 2011 at 9:40 AM

do we trust hundreds of millions of those decisions each year to 15 unelected, unassailable bureaucrats in Washington DC?

If you’re a Leftist technocrat, then hells yeah!

visions on April 20, 2011 at 9:41 AM

Palin was correct….just saying

MCW on April 20, 2011 at 9:42 AM

So 15 people will soon have the power of life and death over almost everyone in the country. Show of hands, who voted for this? On last question, is the board exempt from ObamaCare like the people who instituted it?

Tommy_G on April 20, 2011 at 9:43 AM

Kill the DEATH STAR PANEL!

Khun Joe on April 20, 2011 at 9:43 AM

And more dictatorship coming soon…..

gullxn on April 20, 2011 at 9:43 AM

On should be one

Tommy_G on April 20, 2011 at 9:44 AM

Obama may have made a very large mistake in reopening this political Pandora’s Box in a thoroughly ill-advised speech.

Ed, Scooter just served up a fastball down the middle to Albert Pujols.

If the Republicans don’t run with this, they’re spineless.

kingsjester on April 20, 2011 at 9:44 AM

Obama, political boy genius.

solidaction on April 20, 2011 at 9:44 AM

And, yes, Sarah Palin was right…again.

kingsjester on April 20, 2011 at 9:45 AM

Too bad nobody but a couple of us here at HA noticed this monstrosity while the damn bill was being pushed through Congress.

It’s a canard to suggest that the IPAB can only rule on payments but not restrict treatments. They are the same thing. If the IPAB rules, as the British NICE did, that Medicare will not pay for kidney dialysis for end-stage renal disease patients over age 80 because it is not cost-effective, that is effectivly a death sentence for those patients.

Furthermore, the IPAB will almost certainly be made up not of actual practicing or formerly practicing physicians, it will be made up of academics with degrees in public health, or officials from nurses’ unions. That’s how Obama rolls.

rockmom on April 20, 2011 at 9:47 AM

IPAB = “Independent Physicians Advisory Board” Or “Independent Payment Advisory Board”

Referenced as both above.

Wine_N_Dine on April 20, 2011 at 9:48 AM

And, yes, Sarah Palin was right…again.

kingsjester on April 20, 2011 at 9:45 AM

For such an unserious person, she sure does seem to be near the front of the pack – like a leader – in calling these things correctly.

BadgerHawk on April 20, 2011 at 9:50 AM

0bama has made a huge mistake, here.

OmahaConservative on April 20, 2011 at 9:50 AM

It’s called C-O-M-M-U-N-I-S–M.

rplat on April 20, 2011 at 9:52 AM

If the Republicans don’t run with this, they’re spineless.
kingsjester on April 20, 2011 at 9:44 AM

D’ya think?

darwin-t on April 20, 2011 at 9:52 AM

Heckuva job dear leader

cmsinaz on April 20, 2011 at 9:52 AM

What is worse the 15 member IPAP panel or the oversight of Kathleen Sebelious? No good answer.

fourdeucer on April 20, 2011 at 9:53 AM

Heard shortly after President M.T. Suit left the podium:

The United States and the Presidency is dead.

All Hail Good King Obama I and his Kingdom!

SeniorD on April 20, 2011 at 9:53 AM

but at least Ryan’s plan would allow seniors to find other insurance if coverage for their care got denied

Be serious. You know you are never going to find other insurance (other than at prohibitive cost) once such a condition has been diagnosed and care denied.

cool breeze on April 20, 2011 at 9:53 AM

Uncertain if the overheard remark was made by Lapdancing Media or by Regime Courtiers.

SeniorD on April 20, 2011 at 9:55 AM

BadgerHawk on April 20, 2011 at 9:50 AM

I called this and many other important issues correctly also. Perhaps you should be pushing me for president.

Tommy_G on April 20, 2011 at 9:55 AM

DEATH PANELS !!!

Sarah, once again, was right. We need her to be our President.

stenwin77 on April 20, 2011 at 9:55 AM

My family insurance is going from $1700 and month to $2100 a month in June. Just kill the entire damn bill. It is already destroying the healthcare system and most of it hasn’t taken effect yet. This obamacare is going to increase the number of un-insured and with this death panel…the dead.

bopbottle on April 20, 2011 at 9:57 AM

I nominate Chevy Chase for a seat on the Death Panel.

We have some pain pills in the back, and a pacemaker. The pills will be good for you.

forest on April 20, 2011 at 9:57 AM

The Demorats are putting a lot of power in the hands of the Executive branch of our government. They better think about that because some day (hopefully soon) the other party may sit in the White House. Do they really want all this power in the hands of Sarah Palin?

Herb on April 20, 2011 at 9:58 AM

But not only do Republicans and some Democrats oppose increasing the power of the board, they also want to eliminate it altogether. Opponents fear that the panel, known as the Independent Payment Advisory Board, would usurp Congressional spending power over one of the government’s most important and expensive social programs.

If “some Democrats” are in the Senate, Congress could actually vote to eliminate the IPAB. If that fails or Obama vetoes the bill, since IPAB members need Senate confirmation, the next step is for 47 Senate Republicans to filibuster everyone Obama tries to name to IPAB.

Steve Z on April 20, 2011 at 9:58 AM

Hmmm…death panels.

Who could’ve predicted that?

Oh yeah, I remember. That dumb crazy lady from Alaska.

We need her and 535 more dumb crazy people like her in elected positions in D.C.

Chris of Rights on April 20, 2011 at 9:58 AM

They’d better KJ @ 9:44

Tired of the squishiness

cmsinaz on April 20, 2011 at 9:58 AM

I wonder if the Republican leadership is spineless or purchased and part of the problem behind closed doors. Just say-in…

Keemo on April 20, 2011 at 9:59 AM

cmsinaz on April 20, 2011 at 9:58 AM

Me, too.

kingsjester on April 20, 2011 at 9:59 AM

Opponents fear that the panel, known as the Independent Payment Advisory Board, would usurp Congressional spending power over one of the government’s most important and expensive social programs.

Under the law, spending cuts recommended by the presidentially appointed panel would take effect automatically unless Congress voted to block or change them. In general, federal courts could not review actions to carry out the board’s recommendations.

1) Bypassing an elected legislature.
2) Not allowing a review by an independent judiciary.
There’s only one term for such a system: dictatorship.

rbj on April 20, 2011 at 9:59 AM

Yes Sarah was right once again, but we all know she is not the only ones in the GOP who know this, recognized this, and remained silent to this day. Could it be the establishment politicians are all on the same page and simply issue talking points to make it seem otherwise? Why haven’t our borders been protected no matter which party has been in power? Why did GW increase the size and scope of government just like we’d expect from a Liberal?

Keemo on April 20, 2011 at 10:02 AM

Tommy_G on April 20, 2011 at 9:55 AM

You can be either the Secretary of Education (until the Dept is eliminated) or Ambassador to Guam (until it tips over).

BadgerHawk on April 20, 2011 at 10:02 AM

rbj on April 20, 2011 at 9:59 AM

Soft tyranny. It’s for your own good, so, shut up.

BadgerHawk on April 20, 2011 at 10:03 AM

Independent Physicians Advisory Board (IPAB)

Actually – (DPSCM) Death Panel for Senior Citizens on Medicae

gonnjos on April 20, 2011 at 10:04 AM

Good, someone is recognizing the vulnerability that exists in allowing Ryan’s plan to be demonized.

This is an excellent counter.

It is a choice between “draconian” Death Panels or generous Vouchers that give seniors real choices about their own heath.

Excellent.

petunia on April 20, 2011 at 10:06 AM

If “some Democrats” are in the Senate, Congress could actually vote to eliminate the IPAB. If that fails or Obama vetoes the bill, since IPAB members need Senate confirmation, the next step is for 47 Senate Republicans to filibuster everyone Obama tries to name to IPAB.

Steve Z on April 20, 2011 at 9:58 AM

You’re assuming they WILL be set up for Senate confirmation.
I admire your optimism, at least

pambi on April 20, 2011 at 10:06 AM

Independent Patient Annihilation Board

BadgerHawk on April 20, 2011 at 10:07 AM

I called this and many other important issues correctly also. Perhaps you should be pushing me for president.

Tommy_G on April 20, 2011 at 9:55 AM

And did you also manage to get word out about it to THE ENTIRE WORLD? Didn’t think so.

steebo77 on April 20, 2011 at 10:11 AM

Be careful that he doesn’t pull a Cromwell.

OldEnglish on April 20, 2011 at 10:12 AM

Unbelievable. Trying something that has shown to have failed somewhere else in the world.

Speechless!

Crux Australis on April 20, 2011 at 10:15 AM


Independent health care boards…..Czars……signing statements…….shopping for activists judges…..elected democrats fleeing to Illinois to prevent votes on important issues…..

…………democrats will do anything to subvert the democratic process in pursuit of their liberal agenda.

Baxter Greene on April 20, 2011 at 10:20 AM

The left views old people as shovel ready jobs. First they set up this wonderful healthcare for all the oldsters, promise it will be forever, don’t worry the govt will take care of you, make it so you have to join it at age 65 because the insurance you had will no longer cover you as a primary. Then when you need it most, pull the plug, so to speak, and not provide what you need. Yup, sounds like the end of the ponzi scheme to me.

Kissmygrits on April 20, 2011 at 10:29 AM

That inevitably means that significant numbers of people on Medicare won’t get the care they desire, and thanks to the single-payer system and the fact that the government has already taken the money for those premiums, most of those will have little choice but to suffer more and die more quickly as a result.

From womb to tomb, BHO has no regard for human life.

But we all ready knew that.

GrannyDee on April 20, 2011 at 10:30 AM

BadgerHawk

Odd (and damned inconvenient) how that “Palin called it” thing keeps happening over and over…and OVER again.

Oh…forgot to mention “delightful”.

tree hugging sister on April 20, 2011 at 10:31 AM

Please take a number and get in line for the “death Panel” to assess the cost of your condition.

tim c on April 20, 2011 at 10:34 AM

Medicare hides costs from patients, and is dishonest with health care providers. As long as this situation continues, medical costs will not improve.

Obamacare makes this situation much worse, and injects Death Panels staffed by political appointees into the system. This guarantees that medical care will become scarce and ineffective.

Government-run health care has the perverse effect of diverting health care funds to replace actual health care providers with armies of people whose job is to stare into computer screens and try to prevent health care.

landlines on April 20, 2011 at 10:52 AM

If “some Democrats” are in the Senate, Congress could actually vote to eliminate the IPAB. If that fails or Obama vetoes the bill, since IPAB members need Senate confirmation, the next step is for 47 Senate Republicans to filibuster everyone Obama tries to name to IPAB.

Steve Z on April 20, 2011 at 9:58 AM

Um, will congress vote or will they be Death Czars?

tinkerthinker on April 20, 2011 at 11:01 AM

Odd (and damned inconvenient) how that “Palin called it” thing keeps happening over and over…and OVER again.

Oh…forgot to mention “delightful”.

tree hugging sister on April 20, 2011 at 10:31 AM

delighted also.

tinkerthinker on April 20, 2011 at 11:03 AM

Um, will congress vote or will they be Death Czars?

tinkerthinker on April 20, 2011 at 11:01 AM


Executive Order…He seems to like that now.

mauioriginal on April 20, 2011 at 11:12 AM

The LSM wanted to make Death Panels about end-of-life counseling, but we all know Sarah was talking about the IPAB.

Game On!

JimK on April 20, 2011 at 11:16 AM

Let me get this straight…
This is not a “Death Panel”.
And why is that, now?

Haiku Guy on April 20, 2011 at 11:38 AM

We already have a powerful board charged with deficit reduction.

It’s called the US House of Representatives.

moochy on April 20, 2011 at 11:38 AM

Unbelievable. Trying something that has shown to have failed somewhere everywhere else in the world.

Crux Australis on April 20, 2011 at 10:15 AM

FIFY.

AZCoyote on April 20, 2011 at 11:42 AM

Make sure you give your
Voter Registration Card
To the Death Panel…

For the Democrats,
No expense will be too much
To keep them alive…

But this makes not sense!
Democrats vote anyway,
Even when they’re dead…

Haiku Guy on April 20, 2011 at 11:44 AM

“Placing an unelected panel in charge of spending decisions that Congress only can veto — and doing that through the executive branch rather than the legislative branch — offends the very nature of separation of powers.”

How many more examples do you need…?

“Once is happenstance. Twice is coincidence. Three times is enemy action.”

Seven Percent Solution on April 20, 2011 at 12:04 PM

Look, they’re just smarter than you dummies.

And they’re appointed by someone who was a constitutional law professor!

Aquateen Hungerforce on April 20, 2011 at 12:06 PM

My doctor stopped taking medicare last fall.

ladyingray on April 20, 2011 at 12:24 PM

This has Tommy Boy Daschle all over it.

docflash on April 20, 2011 at 12:28 PM

ObamaCare/IPAB: Redistributing health care benefits to favored constituency groups at the expense of the rest of us.

petefrt on April 20, 2011 at 1:01 PM

ObamaCare/IPAB: Redistributing health care benefits to favored constituency groups at the expense while shortening the lives of the rest of us.

petefrt on April 20, 2011 at 1:02 PM

Do we trust seniors with the decisions for their own care, or do we trust hundreds of millions of those decisions each year to 15 unelected, unassailable bureaucrats in Washington DC?

In other words, death panels. Sarah Palin nailed it, and sent the MSM into panic-schitzo mode because the truth was revealed. Will they nowFINALLY address this? Don’t hold your breath.

(Just an aside, when Paul Ryan mentioned this in his rebuttals, I thought he was saying “iPad” – bad acronym, or an Orwellian way to trick the public think this is just a “good thing”……)

DINORight on April 20, 2011 at 1:07 PM

Obama is an evil man. He demagogues Ryan when hes really the one who wants to harm grandma and grandpa. Sick, evil man this President is. We have to stop this.

jawkneemusic on April 20, 2011 at 1:31 PM

DEATH panel.

say it.

44Magnum on April 20, 2011 at 2:32 PM

IPAB — Rationing, death panels, socialism, and deception.

It’s all there.

tarpon on April 20, 2011 at 3:01 PM

So the question is this. Do we trust seniors with the decisions for their own care, or do we trust hundreds of millions of those decisions each year to 15 unelected, unassailable bureaucrats in Washington DC?

Definitely not the 15 member board, but Seniors have pretty much shown they can’t be trusted with decisions about “their own care” since those seniors keep deciding that my generation should pay for “their own care.” Seniors as a bloc of voters are about like the unions, they vote to redistribute wealth; except instead of high wages and benefits, they want free prescriptions and health care. If seniors don’t want a 15 member board deciding if they need those life-saving drugs, they darn well better stop robbing my generation and pay for it themselves. I’m sick of free-loaders, whether it’s welfare for poverty or health.

Free Indeed on April 20, 2011 at 3:30 PM

The problem with medical care in this country is third-party payment.

The problem will not be solved until we (1) distinguish routine medical care in pre-paid plans from insurance (against catastrophes), (2) remove government from paying for medical services, and (3) create a safety net of vouchers that allow the truly indigent to purchase their own medical services and insurance.

/Mr Lynn

MrLynn on April 20, 2011 at 10:57 PM