Dave Weigel notices that former House Majority Leader Richard Gephardt (D) — who now spends his time lobbying on behalf of health care providers — is opposing the Independent Payment Advisory Board (IPAB), a 15-member commission that would make recommendations to Congress about lowering Medicare spending if costs increase beyond a certain point. From Gephardt’s op-ed:

Under the new law IPAB has been made responsible for suggesting and implementing cuts to Medicare. It is critical that Congress continue to be able to fulfill its duty to the American people and maintain direct oversight of Medicare on behalf of their constituents. Changes to Medicare’s payments should be based on careful consideration of the Medicare program itself — and not arbitrary budget targets.

Under the current law, IPAB will be an unelected and unaccountable group whose sole charge is to reduce Medicare spending based on an arbitrary target growth rate. It will propose cuts to Medicare that Congress can override only with supermajority votes, an unnecessarily high and unrealistic bar. Just as important, these cuts are likely to have devastating consequences for the seniors and disabled Americans who are Medicare’s beneficiaries because, while technically forbidden from rationing care, the Board will be able to set payment rates for some treatments so low that no doctor or hospital or other healthcare professional would provide them.

Since groups like the American Chiropractic Association — which could face cuts under the IPAB — are now signing the front of Gephardt’s paychecks, his opposition is expected, even if his tone isn’t. (There is nothing “unelected” or “unaccountable” about a body that is confirmed by the Senate and sets rates in a transparent manner, for instance.)

But there’s one other problem with his critique. As a long-time proponent of controlling health care costs, Gephardt has supported greater government intervention in the health sector and in 1994 proposed empowering the Secretary of Health and Human Services to establish “target rates of growth” for health costs that included the private sector (thus going further than the IPAB). The following is from the Congressional Budget Office’s (CBO) description of his plan:

The proposal would set target rates of growth for the Medicare program (Parts A, B, and C, together) and for the private sector. It would set Medicare’s payment rates accordingly and would establish a standby system of cost containment for the private sector.

Medicare’s cost controls would go into effect in 1996 for Parts A and B and in 1999 for Part C. The target for total Medicare spending per capita would increase by the rate of growth of gross domestic product (GDP) per capita plus 1.8 percentage points in 1996 and by lesser amounts thereafter. In 2000 and beyond, the target would increase by the five-year average rate of growth of GDP per capita. The per capita estimates would be allocated among 10 or more classes of health care services using complex procedures specified in the proposal The Secretary of Health and Human Services (HHS) would set reimbursement rates for providers, with the goal of meeting the targets.

Spending targets would also be established for the private sector. The per capita targets would be allocated by class of service, as in Medicare, and by state of residence, and the Secretary of HHS would determine maximum payment rates that corresponded to the targets. The maximum payment rates would be only advisory through 2000. Starting in 2001, however, they would become mandatory in states that exceeded their per capita spending target.

Gephardt is not the only critic of the IPAB who supported it in a past life. In 2009, House Budget Chairman Paul Ryan (R-WI) also proposed a plan which sought to establish “two governmental bodies to broadly apply cost effectiveness research in order to develop guidelines to govern the practice of, and payment for, medical care.”

ThinkProgress intern Sean Savett contributed research to this post.

Former Rep. Dick Gephardt (D-MO) is urging the White House to defer the goal of expanding access to health insurance “until it enacts cost-saving reforms in health care delivery“:

“I feel so much now like déjà vu all over again,” said Mr. Gephardt, who now lobbies for corporate America on issues including health care. Universal coverage “is absolutely imperative, and it needs to be dealt with. But the way to get to it is to show that we can deal with some of these problems first”…According to Mr. Gephardt, incremental additions of coverage for children or low-income workers may be the most Congress can muster to complement cost containment.

The administration and most progressives typically argue the contrary: one can’t control health care costs without extending health insurance coverage to the 47 million Americans without insurance. That is, to eliminate the $1,100 an average family is now paying for uncompensated care for those without health insurance, provide families with financial security, and to address the skyrocketing costs of chronic disease management, reform must ensure that all Americans have access to continuous health care.

In fact, during the 2004 presidential campaign, Gephardt spoke of the need to expand access to coverage in such dire and emotional terms, that one would expect the former majority leader to embrace Obama’s commitment comprehensive health reform. During the campaign, for instance, Gephardt promised that if he were elected president, he would “immediately” ensure that “everyone who works will have health coverage.”

Gephardt argued that “access to quality health care is the moral issue of our time” and portrayed himself — in a rather dramatic fight with Gov. Howard Dean (D-VT) — as the only candidate who could address the health care crisis:

- “Howard Dean and the other candidates may think leaving tens of millions of Americans uninsured is acceptable….I think they’re wrong.” [NYT, 01/03/2004]

- Gephardt promised that if he reached the Oval Office he would immediately seek to repeal recent tax cuts. The money would be used to give tax credits to businesses, which would be required to provide health insurance to employees. Pension systems also should be simplified, he said, because too many Americans reach retirement without their finances secure. “Everyone who works will have health care,” Gephardt said. [Chicago Tribune, 02/20/2003]

- “It is immoral to have people without health insurance,” he said, speaking to about 70 people on the lawn of a Manchester home. “This issue is in my heart. It’s in my head. It’s in my soul. I will not rest until I get the people health insurance.” [Chicago Tribune, 07/22/2003]

- “Today in this country there is a great divide, a Grand Canyon between those who have health coverage and those who do not. And for too many, trying to cross from one side to the other is a hopeless pursuit.” [Atlanta Journal-Constitution, 04/24/2003]

- “We have proven our mettle at liberating oppressed peoples. Let us prove our worth at liberating millions of Americans from economic oppression and a life without health care.” [NY Daily News, 04/24/2003]

The current economic crisis demands health reform. Approximately 14,000 Americans are losing health insurance coverage every day, and skyrocketing health care costs could threaten America’s economic growth and prosperity. Containing health care costs is impossible without expanding coverage, and today, the “great divide” “between those who have coverage and those who do not” couldn’t be wider.