by Mitch Kokai
Senior Political Analyst, John Locke Foundation
[T]here was a victory, of sorts, in the bill — the elimination of the Independent Payment Advisory Board (IPAB).
Created as part of the Affordable Care Act in 2010, the IPAB was supposed to be a panel of experts tasked with keeping Medicare spending under control. A great theory, but a total disaster in practice. IPAB was in reality a nugatory body: It never had members nominated, let alone confirmed to it, its budget was slashed again and again, and both Democrats and Republicans wanted to do away with it. …
… The IPAB embodied over a century of various progressive orthodoxies — to the point that former Office of Management and Budget director Peter Orszag’s 2011 defense of the board, in The New Republic, could easily have been written in, say, 1913. The problem with entitlement spending, by this reckoning, is politics: Individual members of Congress favor their own constituencies or donors even when doing so harms the country as a whole. The appropriate response to correct this is to strip Congress of power and transfer it to nonpartisan experts who have the knowledge and dispassion to trim the fat (rather than muscle or bone) from Medicare. …
… But the problem is that Medicare cuts are not like closing military bases. The DOD was more or less able to come up with a set of recommendations that reflected the consensus of experts. But such consensus is elusive with health services. Consider, for instance, the controversy in the fall of 2009 when the government’s Preventive Services Task Force issued new recommendations on breast-cancer screenings. It called for screenings every other year between the ages of 50 and 74, fewer than what medical experts had previously called. In response to a public outcry, Health and Human Services Secretary Kathleen Sebelius had to disavow the government’s own board: “The U.S. Preventive Services Task Force is an outside independent panel of doctors and scientists who make recommendations. They do not set federal policy and they don’t determine what services are covered by the federal government.”
Now, imagine giving the Task Force’s recommendations the force of law, and you get something close to what IPAB could have become: an extremely powerful agency making controversial decisions about health spending.