On Friday, during an event at the Center for American Progress, Dr. Atul Gawande defended the Independent Payment Advisory Board (IPAB) — a 15 member commission formed by the Affordable Care Act that is tasked with controlling health care costs. The board has come under Republican criticism for “rationing” health care to seniors since President Obama announced his intention to expand its functions as a means of lowering health care spending. During his town halls in Wisconsin for instance, Rep. Paul Ryan (R-WI) repeatedly characterized the board as a “rationing” body that would restrict coverage and benefits to current seniors.
But Gawande — a doctor and prize-winning author — argued that while competition is important to reducing health spending, the government should establish a body to ensure that “what we are driving towards are better quality and lower costs“:
GAWANDE: There must me someone setting rules of the road. Competition is invaluable but competition does not drive fair rules that come out of the game and rules that are going to insure that what we are driving towards are better quality and lower costs as time goes on requires that there be a role there and the Independent Payment Advisory Board is the kind of system that we are going to need to evolve towards. It is the kind of a provision that allows us to evolve towards having — not someone who tells me how I do my operations or tries to micromanage those components at the front light– but instead tries to answer how as we evolve along are the payment incentives working — what rules allow things to happen. 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? Are we actually getting better quality and lower costs? And what are we learning as we go along? You need that kind of advisory board that translates that into rules of the road that make us continue to move in that direction.
Unlike insurers, who make coverage decisions every day without so much as holding a public hearing, the IPAB will establish the “rules of the road” in a transparent and accountable manner, considering the needs and suggestions of a broad spectrum of stakeholders. The IPAB will be composed of representatives from drug companies, hospitals, doctors, patients — all of whom are nominated by the president and confirmed by the Senate — who will be tasked with lowering out of control spending. The board will only issue recommendations of health spending increases beyond a specific threshold and is specifically prohibited from restricting benefits or modifying eligibility criteria.