IPAB is Democrats’ Achilles’ heel
| Medicare, Medicaid, and healthcare in general are the issues that Democrats hope to ride to victory in the polls in 2012. My party’s recent victory in the New York special election for the House of Representatives represents welcomed news for Democrats like me. Our recent performance in the polls stems not from Democratic successes (they’re few and far between this Congress) but rather from the Republican Party’s radical plan to abolish Medicare for everyone under 55. Running against the ill-advised proposal proffered by Rep. Paul Ryan (R-Wis.) won the upstate New York special election for Democrats and will continue to be a winning issue for America’s progressives. But we could easily lose this edge when the public figures out that many Democrats support or at least don’t oppose a poorly conceived bureaucracy created under the new healthcare law that will accomplish the same thing they accuse the Ryan plan of doing, gutting Medicare.
The bureaucracy in question is an unelected committee called the Independent Payment Advisory Board (IPAB) that will be charged with controlling Medicare’s budget. I thought that was the job of Congress. IPAB will have the authority to lower provider payments without being accountable to the American people, potentially disrupting the flow of much-needed quality care to millions of Medicare patients across the country. As structured, it will also make it next to impossible for Congress to address or change board decisions once they have been implemented. In the long run, this type of unaccountable cost cutting could damage Medicare almost as much as the Republican plan. Republicans running against IPAB could deflect Democrat’s effective and correct attacks on the Ryan Plan. My party would be vulnerable to these attacks since almost every Democrat now in Congress voted for IPAB while only seven House members and not a single Democratic Senator have joined 115 Republicans supporting its elimination. So a message to my fellow Democrats: Get the courage to admit we were wrong to create IPAB and commit to replacing it with measures that emphasize results and prevention. A forthright admission that IPAB should not exist should start the process. If it passes Congress with a decent amount of Democratic support, President Obama would have no politically practical way to reject a bill getting rid of IPAB, and (as an added benefit to my fellow Democrats) Republicans would lose their best argument for the total repeal of the health care law. Solutions, in the form of better care coordination and a new emphasis on prevention, should follow close behind. The health care law already contains a number of incentives to encourage doctors and hospitals to work together more closely, share data better, and integrate the efforts of primary care physicians, nurses, medical specialists, home health aides and others. Early experiments (some of which wouldn’t exist under IPAB) have shown that better coordination saves money while improving health outcomes. Just as importantly, Medicare needs to focus on prevention rather than treatment. Over 95 percent of Medicare beneficiaries have one or more chronic conditions like diabetes, asthma, or osteoporosis. Treating these diseases consumes over 80 percent of Medicare’s budget. Efforts to make these treatments smarter – interventions as simple as offering consistently better diet counseling to diabetics – could save far more money than IPAB’s heavy-handed mandates while improving healthcare. Republicans are wrong to try and abolish Medicare but the Democratic Party is open to attacks over its support for IPAB. The two parties need to work together and eliminate the board. Once IPAB is gone, my fellow Democrats can lead the way in proposing better solutions to the nation’s healthcare financing challenges. |