According to a story in The New York Times today, some congressional Democrats are now joining Republicans in opposition to the Independent Payment Advisory Board (IPAB), a feature of the Affordable Care Act meant to help control costs in Medicare, and by extension in the American health-care system as a whole. The IPAB will be a panel of health-care experts that will attempt to find ways to rein in spending, and critically, their decisions will have the force of law unless Congress and the president overrule them.
It's easy to see why members of Congress would be opposed to this: It takes away their prerogative to set Medicare's rules. And as you know, your average member of Congress has a great deal of health-care expertise. Right now, members of Congress get lobbied by a whole series of groups -- seniors, doctors, hospitals, device manufacturers -- all of whom push in a single direction: to get Medicare to pay as much as possible for every possible device, procedure, and service. When the IPAB is in place, there will be someone within the system able to push back.
You may remember that a year and a half ago, during the reform debate, a government task force issued a recommendation that it was not necessary for every woman between the ages of 40 and 50 to get a yearly mammogram. Republicans pounced, screaming that this unenforceable recommendation was exactly the kind of "rationing" they feared, and the ACA had to be stopped lest government bureaucrats kill your grandmother. They also opposed any effort by the government to fund "comparative effectiveness research," wherein different treatments are compared to see which work best. They didn't even want to know, arguing instead that Medicare should just pay for everything, regardless of how much it costs or whether it works.
Yet today, those same Republicans who opposed any attempt to hold down Medicare spending in an informed way argue that Medicare costs threaten the survival of the country, and therefore we must privatize the program and shift costs onto seniors' backs. The fact is that the health-care system rations today, and it will ration tomorrow. The question is how. The Republican solution is to ration by wealth: They'd have Medicare pay an increasingly small portion of seniors' premiums; those who can afford more comprehensive coverage will get it, and those who can't will be left with inadequate coverage that won't pay for everything they need. On the other hand, you can attempt to ration in a rational way, a way in which health-care experts have greater influence over the process than a bunch of lobbyists or some nincompoop congressman from Texas (yeah, I'm thinking of you, Louie). It's our choice, but we have to choose.
