The Independent Payment Advisory Board comes under fire

THE INDEPENDENT PAYMENT ADVISORY BOARD COMES UNDER FIRE…. Just about everyone, regardless of party or ideology, wants to see steps taken to lower health care costs, especially in Medicare, and expects leading policymakers to step up with creative and constructive ideas.

But the same thing tends to happen when leaders actually put ideas on the table: they’re immediately hated and rejected.

Last week, for example, President Obama explained that the nation can “slow the growth of Medicare costs by strengthening an independent commission of doctors, nurses, medical experts, and consumers who will look at all the evidence and recommend the best ways to reduce unnecessary spending while protecting access to the services that seniors need.”

He was referring, of course, to the Independent Payment Advisory Board, a provision in the Affordable Care Act. This week, we’re once again seeing fierce opposition to the worthwhile idea.

Democrats and Republicans are joining to oppose one of the most important features of President Obama’s new deficit reduction plan, a powerful independent board that could make sweeping cuts in the growth of Medicare spending.

Mr. Obama wants to expand the power of the 15-member panel, which was created by the new health care law, to rein in Medicare costs.

But not only do Republicans and some Democrats oppose increasing the power of the board, they also want to eliminate it altogether. Opponents fear that the panel, known as the Independent Payment Advisory Board, would usurp Congressional spending power over one of the government’s most important and expensive social programs.

Everyone wants to lower costs until someone tries to lower costs.

I can understand why the IPAB idea is contentious, but there’s no real scandal here. Paul Krugman explained today, “Arguably the most important thing we can do to limit the growth in health care costs is learning to say no; we cannot afford a system in which Medicare in particular will pay for anything, especially when that’s combined with an industry structure that gives providers a strong financial incentive to engage in excessive care.”

To address this, the Obama administration wants IPAB to make the difficult decisions, free of the political process on Capitol Hill, precisely because Congress has failed in its ability to make these choices on its own.

This probably seems like an obscure aspect of the larger debate, but it’s pretty simple: do lawmakers want to lower Medicare costs or not? If they kill the Independent Payment Advisory Board, and take away one of the single most realistic tools to actually lower costs, what will they replace it with?

Alas, the politics of this are exasperating and counter-productive. Ezra Klein had a good overview on how IPAB addresses a real problem, and why that’s causing political problems.

You’d still have the traditional Medicare claimants running to their member of Congress to complain [after IPAB decisions], but now he or she would be able to say, “there’s nothing I can do,” and, even better, “it’s not my fault.” IPAB’s recommendations can’t be amended and they can’t be filibustered, so individual members have vastly less control over the process than they traditionally have. All Congress can do is fully replace an IPAB recommendation with a reform that saves the same amount of money or muster both a supermajority and a presidential signature to stop IPAB from acting. Either path requires a lot more effort than undermining cost control does right now.

That’s (a) why IPAB is promising and (b) why a lot of members of Congress want to get rid of it and replace it with something that interest groups like better. In that way, the IPAB repeal effort is a useful way of sorting the legislators who want to control Medicare’s costs from those who want to preserve their power to keep Medicare’s costs from being controlled.

After all the recent talk about “seriousness,” it’s worth keeping this in mind: those railing against IPAB and Medicare costs at the same time do not deserve to be taken seriously.