White House OMB Director Peter Orszag has a column in today’s NYT that illustrates part of why so many are so implacably opposed to Obamacare. A large part of the column deals with ways in which the law is supposed to save money. He admits, for example, that billions have been cut from Medicare payments to providers—and that this could make it harder to find a doctor. But let’s not get into that here.
The part of his column that I want to focus on—which should send a cold chill up all of our spines—mentions the quasi Star Chamber powers granted to the Independent Payment Advisory Board to control Medicare costs. From his column, “To Save Money, Save the Health Care Act:”
Perhaps most important, the legislation creates an Independent Payment Advisory Board, a panel of independent medical experts who will look for more ways to improve Medicare’s cost-effectiveness. Under the law, any policy that the board issues takes effect unless legislation to block it is passed by Congress and signed by the president. This way, inertia works in favor of cost containment rather than against it.
There’s a lot about the IPAB that Orszag doesn’t mention. For example, Congress MUST pass the recommendations or they become effective. He also doesn’t mention that even if the president vetoes the law so passed , the rules take effect anyway. From an explanation from the AMA:
Fast-track legislative process:
• By Jan. 15 of each year, beginning in 2014, the IPAB must submit a proposal to Congress and the president for achieving Medicare savings targets in the following year...
• The House and Senate Majority Leader or their designee must introduce the IPAB proposal the same day it is received (or on the first day the chamber is in session). If the proposal is not introduced within five days, any senator or representative can introduce it...
• By April 1, the committees of jurisdiction are to complete their consideration of the proposal. Any committee that fails to meet that deadline will be discharged from further consideration.
• Congress cannot consider any bill or amendment that does not meet the IPAB targets or that would repeal or change the fast-track congressional consideration process without a three-fifths vote (60) in the Senate. Non-germane amendments are not permitted.
• The HHS secretary must implement the IPAB proposal on Aug. 15 of the year in which the proposal is submitted. Recommendations regarding the physician fee schedule would take effect on Jan. 1 the following year.
If Congress does not pass the proposal before Aug. 15, or if the president vetoes the proposal as passed by Congress, the original IPAB recommendations would take effect.
This is not what the Founding Fathers had in mind.
Worse, he somehow forgets to mention that the IPAB’s decisions, once not vetoed by law, are removed from the power of court and administrative review! From the Kaiser Family Foundation fact sheet, “Focus on Health Care Reform:”
Implementation of the Board’s recommendations by the Secretary is not subject to administrative or judicial review. The establishment of the Board represents the first time that the Medicare program will be subject to spending limits, with statutory requirements to achieve savings targets.
How telling that President Obama’s chief bean counter sees this bureaucratic oligarchy, almost a law unto itself, as “perhaps the most important” part of Obamacare.
The IPAB is anti freedom. While not (yet) authorized to ration care, it removes crucial policy decisions from direct democratic processes and normal petitioning of government. It takes important policy making responsibilities away from accountable and reachable (in theory) elected officials who should make them, and hands fiscal power to unelected,unaccountable, bean counters that will primarily come from the bioethics mainstream. And it stops the courts from reviewing the decisions that are made. That’s a prescription for tyranny, that once successfully implimented, will spread to other contentious areas of policy.
The New Congress was elected to stop the monstrosity that is Obamacare. One of its first acts should be to refuse to fund the IPAB so that it can’t be operated. Sure, create a board to advise on cutting costs and budgetary matters—but strip from it the power to impose. Americans don’t want to be ruled by bureaucrats.
