Friday, June 24, 2011

The Facts about IPAB’s Road to Rationing

Secretary Sebelius has an op-ed in Politico this morning regarding Obamacare’s Independent Payment Advisory Board, a 15 member board that will recommend ways to reduce Medicare spending.  Several specific assertions in the article merit comment and rebuttal:

  • The Secretary notes that the board will be “made up of 15 health experts,” including “economists.”  This admission – coupled with the statutory requirement that a majority of IPAB members NOT be practicing medical providers – effectively means that many of the members of the board will be proverbial bean-counters, focusing on bottom-line ways to contain costs rather than ways to improve care.
  • The Secretary states that “contrary to critics’ contentions, the board’s work will be transparent, independent, and accountable to Congress and the President.”  That’s an interesting assertion, seeing as how Section 3403 of the statute (which established IPAB) includes NO requirement for public comment prior to IPAB issuing its recommendations.  Specifically, 42 USC 1395kkk(i)(1), as created by the law, indicates that IPAB “may hold such hearings…take such testimony, and receive such evidence as the Board considers advisable.”  The statutory language provides about as firm a commitment to transparency as the President’s promise to televise all health care negotiations on C-SPAN.
  • The Secretary notes that IPAB’s “recommendations must improve care and help control costs.”  In other words, if a treatment, method, or process would save or extend a million lives, but cost Medicare a million dollars, the IPAB is prohibited from recommending that particular therapy.  How will this constraint help patients?
  • The Secretary claims that “the claims that the board will ration care are simply false.”  But the Medicare actuary – and others – have noted that the kind of payment reductions contemplated by IPAB amount to de facto rationing by reducing access to care.  The actuary has stated that the payment reductions in the law could “jeopardize[e] access to care for beneficiaries,” and that the IPAB reductions in particular would be “difficult to achieve in practice,” because of the access-related harm to seniors that would result.
  • The Secretary alleges that the health care law “extended the solvency of the Medicare Trust Fund.”  That statement lies in direct contrast to President Obama himself, who in an interview with Fox News last year admitted that “You can’t say that you are saving on Medicare and then spending the money twice” – once to extend Medicare’s solvency, and a second time to fund new entitlements for other Americans.
  • The Secretary alleges that “economists and the Congressional Budget Office believe this approach [i.e., IPAB] will work.”  On the latter point, the Secretary is making a demonstrably false statement.  Just this Wednesday, the CBO’s latest version of the long-term budget outlook EXCLUDED savings from the IPAB in calculating its alternative fiscal scenario, because it believes the IPAB payment reductions will be “difficult to sustain.”

Democrats and the Administration continue to assert that the IPAB approach will help, not harm, patients.  If that’s the case:

  • Why did the statute not require IPAB to take comments from the public before making its recommendations?  Just last month the Administration proposed requiring state Medicaid programs to obtain public comments before reducing provider reimbursement levels.  Why is the Obama Administration imposing public comment requirements on state Medicaid programs, but not imposing a similar requirement on its controversial IPAB?
  • Why is the IPAB exempt from administrative and judicial review?  If no patients will be harmed by IPAB’s recommendations, then why are Medicare beneficiaries prohibited from taking legal action against it?
  • Will Secretary Sebelius commit to following IPAB’s recommendations herself?  Or will Democrats and others who claim they support “experts” making health care choices use their own resources to buy themselves out of a rationing regime if IPAB restricts access to services and treatments they need?