The Ties That Bind? A Response to Doug Schoen

Our guest blogger is Neera Tanden, Chief Operating Officer at the Center for American Progress, who most recently served as senior advisor for health reform at the Department of Health and Human Services, advising Secretary Kathleen Sebelius and working on the president’s health reform team to pass the bill.

Yesterday as Washington was gripped by the contentious debt limit debate, Doug Schoen, a pollster by trade, took to the Huffington Post to assault the Independent Payment Advisory Board (IPAB) — a 15-member board of medical experts that was created by a provision in the Affordable Care Act. The board, whose members will be appointed by the President and confirmed by the Senate, is tasked with making binding recommendations to reduce expenditures in the Medicare system, unless Congress acts to alter the proposal or discontinue automatic implementation.

Schoen argues that IPAB will have to make steep cuts to meet annual targets. However, today, Republicans are proposing initiatives to dramatically cut Medicare, as the Ryan plan does and House Speaker John Boehner’s debt ceiling measure will likely do. Schoen says that changes to Medicare should be decided by elected officials, who will be held accountable for their decisions. But right now, members of Congress can lobby the Centers for Medicare and Medicaid Services to pay for unnecessary or untested treatments that drive up costs.

The purpose of the IPAB is to ensure policies are not based on the special interests of legislators. Indeed, the IPAB will be comprised of medical experts who can spend the time crafting policies to lower Medicare expenses while improving quality of care and Congress can override the recommendations if they choose. The question really is, do we prefer Congress making decisions on health care delivery instead of doctors, consumer leaders and other medical experts? By taking the politics out of the equation, meaningful payment reform and cost containment can be achieved, as it will not be hindered by payment providers’ undue influence. In fact, lawmakers who oppose the IPAB have received hundreds of thousands of dollars in campaign contributions from health care companies. This political sway was one of the key reasons Senator Jay Rockefeller (D-WV) constructed the IPAB model, stating “It is long past time that Medicare payment policy is determined by experts, using evidence, instead of by the undue influence of special interests.” To further ensure independence, a majority of members must be non-providers and cannot hold any other jobs.

Schoen applauds the ability of other elements of the law to control costs and I too share that belief. However, I would note that previously he attacked the law as a failure. I hope that Schoen is correct that the threshold to activate the IPAB will not be met, as that means other cost controls implemented through the ACA – like the excise tax and system modernizations – have been effective in curbing spending.

Aside from Schoen’s flawed arguments, I wondered why Doug Schoen is even writing about the IPAB. Doug Schoen is, after all, a pollster – yet he cited no polls in his piece (and ignores polls that show Americans have more trust in “an Independent panel of full-time experts appointed by the president and confirmed by the Senate” proposing ways to reduce Medicare spending than Congress or a federal agency). And, as far as I know, he’s not a health care expert. It’s true he does have a penchant to articulate arguments to attack the President politically that parrot Republican talking points. Recently he argued for the President not to even bother running for reelection.

I thought perhaps Schoen, who has worked at polling firms in the past, had clients like pharmaceuticals or medical device companies, since the IPAB may well ensure that ineffective practices that bring in money are eliminated — but then I assume he would disclose such relationships. If not, it could be that Doug Schoen has taken a new interest in health care and we should welcome him to the debate. The Huffington Post is a platform for well-known Washington figures to address important issues. But when those figures have clients affecting their views, we should know.