Obamacare: Laying the Cornerstone of a Bureaucratic State

I mentioned the problems with Obamacare’s creation of a Medicare Independent Payment Advisory Board in a previous post.  But I thought it so important, I asked the Weekly Standard if I could opine at greater length, and they agreed.

Obamacare gave IPAB’s unelected “expert” bureaucrats, in essence, the right to pass legislation: From “Our New Obamacare Masters:”

Saying, in effect, “Stop us before we spend again,” Democrats transferred most of Congress and the president’s policy-making authority to the 15 “expert” members of the Independent Payment Advisory Board, appointed by the president and confirmed by the Senate. If this board determines that the growth of Medicare costs will exceed a predetermined target, it has the power to enact a remedy through “fast track” legislation, which works like this:

• By January 15 each year, the Independent Payment Advisory Board must submit a proposal to Congress and the president for reaching Medicare savings targets in the coming year. The majority leaders in the House and Senate must introduce bills incorporating the board’s proposal the day they receive it.

• Congress cannot “consider any bill, resolution, amendment, or conference report??…??that would repeal or otherwise change the recommendations of the board” if such changes fail to meet the board’s budgetary target.

• By April 1, the committees of jurisdiction must complete their consideration of the proposal. Any committee that fails to meet the deadline is barred from further considering the bill.

• The secretary of health and human services must implement the Independent Payment Advisory Board’s proposal, as passed by Congress and signed by the president, on August 15 of the year in which the proposal is submitted.

• If Congress does not pass the proposal or a substitute plan meeting the Independent Payment Advisory Board’s financial target before August?15, or if the president vetoes the proposal passed by Congress, the original Independent Payment Advisory Board recommendations automatically take effect.

Further demonstrating the Star Chamber-like powers of the Independent Payment Advisory Board, Congress cannot consider any bill or amendment that would repeal or change this fast-track congressional consideration process without a three-fifths vote (60) in the Senate. Not only that, but the implementation of the board’s remedy is exempted from administrative or judicial review.

This is bigger than Obamacare. Handing such raw power to bureaucrats could deleteriously impact American democracy:

Nor is there any reason to believe that the Independent Payment Advisory Board’s undemocratic approach to governance would long remain limited to Medicare. If our controversy-averse elected officials ever think they can protect their jobs by delegating their most difficult decisions to unaccountable commissions—as Congress did with regard to setting its own salaries—independent “advisory” boards could proliferate. In this sense, the success of Medicare’s new cost-containment board could portend the construction of an unaccountable bureaucratic state.

When the Founding Fathers wrote the Constitution, they did not envisage governance by “we the experts.” Regardless of where one stands on the wisdom of Obamacare generally, the unaccountable power of the Independent Payment Advisory Board as a mini-government within a government needs to be revoked by the new Congress, and if that proves undoable, its organization and staffing should be defunded.

Controlling costs is important. Maintaining a responsive and accountable-to-the-voters government is even more crucial.