It’s worth considering Sarah Palin’s new claim that the Independent Payment Advisory Board (IPAB) — one of the few cost control mechanisms in the Affordable Care Act — will lead to “death panel”-like rationing, if only to bury it once and for all for the absurdity that it is. First, look at how Palin described the IPAB in today’s Wall Street Journal editorial:
[The deficit commission] also implicitly endorses the use of “death panel”-like rationing by way of the new Independent Payments Advisory Board—making bureaucrats, not medical professionals, the ultimate arbiters of what types of treatment will (and especially will not) be reimbursed under Medicare.
In actuality, the board is something different. Beginning in 2014 the 15-member board that will offer Congress a comprehensive proposal to reduce excess cost growth in Medicare. As Section 3403 (page 409) of the law stipulates, the proposal cannot “include any recommendation to ration health care, raise revenues or Medicare beneficiary premiums…increase Medicare beneficiary cost- sharing (including deductibles, coinsurance, and co- payments), or otherwise restrict benefits or modify eligibility criteria.” When Medicare costs are projected to be unsustainable, the proposal will take effect unless Congress passes an alternative measure that achieves the same level of savings. The deficit commission expands IPAB by allowing it to “make recommendations for cost-sharing and benefit design and to look beyond Medicare.”
But what’s ironic about Palin’s claim is that she makes it in the course of endorsing Rep. Paul Ryan’s ‘Roadmap’. By Palin’s standards, that proposal would have a far more significant effect on denying seniors access to care than anything in the health law. Briefly, under the Roadmap individuals who are age 65 or older in 2020 would continue in the current Medicare program, while those who will become eligible for Medicare after 2020 would be given a voucher with which to purchase private health insurance. Here is how the Congressional Budget Office (CBO) describes the consequences of that policy (pg. 10):
Under the Roadmap, the value of the voucher would be less than expected Medicare spending per enrollee in 2021, when the voucher program would begin. In addition, Medicare’s current payment rates for providers are lower than those paid by commercial insurers, and the program’s administrative costs are lower than those for individually purchased insurance. Beneficiaries would therefore face higher premiums in the private market for a package of benefits similar to that currently provided by Medicare. Moreover, the value of the voucher would grow significantly more slowly than CBO expects that Medicare spending per enrollee would grow under current law. Beneficiaries would therefore be likely to purchase less comprehensive health plans or plans more heavily managed than traditional Medicare, resulting in some combination of less use of health care services and less use of technologically advanced treatments than under current law. Beneficiaries would also bear the financial risk for the cost of buying insurance policies or the cost of obtaining health care services beyond what would be covered by their insurance.