Obamacare will be disastrous for Medicare recipients. $500 billion came out of the program to help make Obamacare appear (through smoke and mirrors) to be fiscally responsible. Worse, it established the anti democratic and bureaucratically unaccountable quasi Star Chamber known as the Independent Payment Advisory Board, authorized to order Congress to legislate cost cuts (resisted only by a supermajority)—with (as I wrote in the Weekly Standard) the constitutionally questionable power to even surmount a presidential veto.
Despite the terrible consequences that IPAB’s decrees could impose on Medicare recipients, the AARP continues to support its bureaucratic authoritarian authority. From a story in the Boston Globe about Big Biotech’s opposition to IPAB:
That argument [job destruction] doesn’t surprise John Rother, executive vice president of policy and strategy at AARP. The powerful lobbying group for the elderly views the advisory board as crucial to holding down Medicare costs. “The whole rationale for IPAB is to do an end run around the lobbying power of certain health industries, so obviously they are trying to protect their turf,’’ said Rother. “It’s so easy to scare old people but hopefully, people can see the motivations.’’
Getting around “lobbying power” means subverting democratic accountability and destroying representative governance.
But beyond this too little discussed principle of American constitutionalism, seniors should be beyond “scared” of the IPAB’s near absolute cost-cutting power. Indeed, the potential harm is so dire, AARP’s continued political support for IPAB betrays the very demographic cadre the organization purports to represent.
Consider: Efforts to control costs generally involve reducing physician and hospital compensation. These reductions would make it almost impossible for Medicare patients to obtain doctors willing to treat them for what Medicare pays, and would devastate hospital bottom lines. As a consequence, Congress regularly passes the “doctor fix” to prevent the system from collapsing in on itself. But IPAB would be immune from the political pressures that result in the doctor fix. Indeed, that was the precise reason why it was spawned—to impose reductions without regard to the political or practical consequences.
And it wouldn’t stop there. President Obama has stated, even before the iron fist throws its first punch, that he wants IPAB’s currently limited powers of cost cutting expanded. This could one day include explicit rationing and changes in benefits. And while private insurance companies foolishly support IPAB now thinking it will save them money (according to the Globe story), that myopia is ultimately self destructive. Powerful voices—such as that of the New England Journal of Medicine—want IPAB to be able to control the private sector as well as Medicare. If that happens, it will be the end of the private health insurance industry and hello single payer (which may be the point).
There is no questions Medicare and health costs generally need to be controlled. But IPAB leads us away from governance by the people as it threatens to destroy health care accessibility. Better to unleash point of service cost competition, permit eligibility and benefits means testing for Medicare, and have the government underwrite the costs (as in the very successful Part D Medicare) than turn our medical system into a mirror image the European Union’s bureaucratic nightmare known as “Brussels.”
