Broder is hard to please

BRODER IS HARD TO PLEASE…. In his latest column, the Washington Post‘s David Broder takes aim at a provision of health care reform that he finds potentially problematic: the creation of an Independent Medicare Advisory Council (IMAC).

As proponents see it, appointed IMAC members — physicians and medical experts — would have some added authority to help control what Medicare pays doctors and hospitals. The panel would ideally help lower costs more effectively than Congress.

The idea makes Broder uncomfortable.

Americans are familiar with — if not altogether comfortable about — unelected officials exercising great authority over our lives. The nine justices on the Supreme Court and hundreds of other jurists exert their power from the bench. The economy is managed by the Federal Reserve Board, though no one ever forced Alan Greenspan or Ben Bernanke to campaign for a vote.

If President Obama has his way, another such unelected authority will be created — a manager and monitor for the vast and expensive American health-care system. As part of his health-reform effort, he is seeking to launch the Independent Medicare Advisory Council, or IMAC, a bland title for a body that could become as much an arbiter of medicine as the Fed is of the economy or the Supreme Court of the law.

The idea has gained a warm initial reaction on Capitol Hill. But with the delay in action on the overall reform effort until fall, there will be more time for reflection on IMAC and its authority.

Broder concluded that “Americans will have to decide” if they’re comfortable with “five unelected IMAC commissioners” determining “how they will be treated when they are ill.”

I’m a little surprised by Broder’s apprehension. After all, the IMAC idea was proposed by the right, and accepted by the left, as part of a larger effort to save money and take political considerations out of the process. In other words, it’s an idea with bipartisan appeal, with an eye towards fiscal responsibility. Isn’t this exactly the kind of policymaking Broder says he wants?

Mark Kleiman added, “Forget the fact that the ‘five unelected commissioners’ will be appointed by the President and confirmed by the Senate, that their recommendations can’t take effect without the President’s approval, and that even then they could be over-ridden by the Congress. I’d rather have five unelected commissioners, or five names drawn at random from the phone book, determine how I will be treated than have that determination made by an unelected insurance-company bureaucrat whose employer makes money by denying me care.”