The Case For The IPAB

As the GOP steps up its attacks against the Independent Payment Advisory Board (IPAB) — a 15 panel commission that would make recommendations for lowering Medicare spending to Congress — Matt Yglesias suggests that the very same Republicans who argue the IPAB would ration care are “the very same members of congress who voted this month to privatize Medicare in 2022 and enact draconian cuts throughout the 2020s and 2030s are here in town right now defending health care providers’ right to charge the government high prices for services that don’t work.” But now, some Democrats are also distancing themselves from the IPAB, arguing that the board’s structure — its cuts would go into effect unless Congress acts — usurps Congressional authority. Jonathan Cohn has those details:

But now some Democrats are joining the calls for repeal, as Jennifer Haberkorn first reported in Politico last week and as Robert Pear notes today in the New York Times. The IPAB was never particularly popular with more liberal House Democrats, who didn’t want to cede power over Medicare to another authority. But, at least for the moment, opposition is coming from a different part of the caucus. The Democrat leading the charge against the IPAB right now, for example, is Allyson Schwartz, a self-proclaimed New Democrat who represents the northeastern Philadelphia and the nearby suburbs.

Why does Schwartz want to get rid of IPAB? In a letter announcing her intentions, Schwartz said it was undemocratic to hand over that authority to a commission. And that’s a legitimate (if, in my view, unpersuasive) argument.

So Republicans are claiming that the board will ration — even kill — seniors, while Democrats are suggesting that Congress can do a better in controlling health care spending. I would argue that both are wrong. As to the GOP’s argument, the board kicks in if health care spending increases beyond a specific threshold and is specifically prohibited from rationing. The IPAB’s recommendations 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,” Section 3403 (page 409) of the Affordable Care Act stipulates.

As to the Democratic criticism, I would argue that it’s far better to have representatives of the various stakeholders in health care — drug companies, hospitals, doctors, patients — (all of whom are nominated by the president and confirmed by the Senate) making these decisions in a transparent, public, and accountable manner and then submitting their plan to Congress for a vote, than resting the cost-cutting powers in the hands of politicians and lobbyists who will undoubtedly reach their decisions without any kind of public input.