It stands for the Independent Payment Advisory Board, a vastly powerful but too often overlooked component of the president’s health-care-reform law. IPAB has not yet come into existence, but when Obamacare goes into full effect, it will be an unelected and unaccountable bureaucratic entity with nearly limitless power over federal Medicare spending. IPAB will have the power to effectively ration health care through price controls — which may not even be the scariest thing about it. That distinction arguably falls to its unprecedented overriding of congressional sovereignty, in flagrant violation of the constitutional separation of powers.
Obama in a response to an April 13 speech in response to Paul Ryan’s deficit-reduction plan did push IPAB out of the shadows and into public view. Obama made clear in that speech that IPAB’s authority over Medicare pricing would be a central component of his deficit-reduction plan, and he used the occasion to call for a substantial expansion of IPAB’s already unprecedented powers.
Obama can’t begin to match Ryan’s deficit-reduction program without massive, IPAB-imposed health-care controls that would amount to rationing.
The IPAB controversy raises anew longstanding concerns about President Obama’s political convictions and methods: his radicalism, ideological stealth, and long-term intentions. An emerging bipartisan movement to abolish IPAB highlights the fact that many moderate Democrats have been uncomfortable with this board from the start. IPAB’s central role in Obama’s plans suggests that, despite his denials, the president has never truly surrendered his aim of driving America toward a socialized, British-style single-payer model, in which our entire health-care system would be government-run.
While almost nothing about IPAB has been subject to public debate, almost everything about it should be controversial. Paul Ryan calls IPAB a “rationing board,” to which the White House replies that IPAB is specifically prohibited by law from rationing care. IPAB is indeed legally barred from formal rationing, but with its authority to control prices, it will be able to drive Medicare payments so low that doctors will simply stop offering key services to patients. In theory, Medicare would still pay for a whole range of tests and treatments, but in practice, patients solely dependent on Medicare would be barred from a great many of them. That is de facto rationing.
Of course, as with the Ryan plan, Medicare patients would still have the option of paying for non-reimbursed care out of pocket — that is, until IPAB helps usher us into a fully socialized single-payer health-care future (of which more below).
So is IPAB a “death panel”? Not exactly, at least in the sense of explicitly deciding who shall live and who shall die. Yet IPAB’s price-setting power gives it control over medical decisions now made by doctors with their patients. And, yes, that means rationing by unaccountable bureaucrats. The one-size-fits-all consequences of IPAB’s declarations will be final for many an unfortunate patient. In that sense, IPAB will indeed be a death panel. Ryan’s plan returns some of that money to Americans via a tax-supported health-care voucher. This allows consumers to choose the private insurance plan that most closely matches their priorities — devoting more or less resources to end-of-life care, for example.
Yet the constitutional problems surrounding IPAB are at least as disturbing as the lack of choice. IPAB’s defenders euphemistically refer to its unprecedented powers as “fast-tracking,” as if clever efficiency experts were simply speeding IPAB’s decisions through the usual legislative process. In reality, IPAB upends, short-circuits, and refashions the fundamentals of American government in ways that make a mockery of the Constitution.
Peter Orszag, former director of Obama’s Office of Management and Budget — and an enthusiastic IPAB supporter — once called IPAB “the largest yielding of sovereignty from the Congress since the creation of the Federal Reserve.” Arizona’s Goldwater Institute, which has filed a lawsuit against Obamacare that focuses on IPAB, argues that IPAB’s largely unchecked power over the nation’s health-care system will actually exceed the Federal Reserve’s control of the banking system, as well as the Environmental Protection Agency’s reach.
The basic principle is that IPAB’s recommendations will have the force of law unless they are countered by Congress. And Obamacare makes them exceedingly difficult to counter. Congress can modify IPAB’s decisions through its ordinary procedures only if Congress’s total Medicare expenditures do not exceed IPAB’s recommended levels. It takes a three-fifths supermajority of the Senate to waive these restrictions. In addition, IPAB’s recommendations must be moved through Congress according to a specific timetable. This “fast-tracking” supersedes even the Senate’s standing rule requiring 60 votes to invoke cloture in case of a filibuster.
And it may not end there. Under the current version of the law, Congress retains the option of passing separate legislation authorizing additional Medicare expenditures. As part of his response to Ryan, however, President Obama called for IPAB to be granted the power of “automatic sequester.” While the White House has done little to fill out the details of this audacious proposal, it apparently means that IPAB would be able to prevent Congress from appropriating any additional money for Medicare outside of IPAB-initiated legislation. Oh, and by the way, the Obamacare legislation exempts IPAB’s recommendations from either administrative or judicial review.
if one Congress can broadly regulate the actions of a future Congress in this way, will likely only be clarified in practice.” Orszag notes, IPAB essentially captures a substantial portion of the sovereignty granted to Congress by the Constitution and transfers it to a semi-independent entity within the executive branch, freed from judicial review to boot.
Its attack on individual liberty and democratic accountability, as embodied in America’s system of constitutional self-rule, tells you all you need to know about Obamacare and the man it’s named for. John Fleming (R., La.), a co-sponsor of the House legislation to repeal IPAB, calls the panel a Soviet-style “central planning committee.” He’s right. Even in the absence of a single-payer system, IPAB’s centrally planned and democratically unaccountable price-setting authority pulls us far down the road to socialism. Socialism inhibits liberty, and IPAB’s panoply of restrictions on democratic self-rule are the logical corollary of command-and-control central planning.
Claremont Institute scholar Charles Kesler has forcefully argued that Obamacare will be repealed and Obama himself defeated only when the public recognizes that the very “future of self-government in America” is at stake in this debate. If IPAB stands, the door is open to further ceding of congressional authority to boards and panels and commissions. If an extraconstitutional health-care rationing board is required to rescue us from a debt crisis driven by rising health-care costs, why not unaccountable energy-rationing or carbon-rationing boards to rescue us from an oil-price spike or the supposed crisis of global warming?
(CBO) projections, IPAB’s legislated cost-cutting targets will likely fail to bite over the next ten years. Curiously, a week after Obama’s reply to Ryan, White House deputy chief of staff Nancy-Ann DeParle actually touted this fact, virtually boasting that IPAB would do nothing to save money for a decade. Nick Papas acknowledged, under questioning from Fox News, that Obama’s new IPAB proposal would indeed have some fiscal impact before the decade is out.
If Obama can disguise the true long-term impact of IPAB’s price controls on Medicare, he wins.
Obama’s approach is to promise eventual savings from IPAB, while never actually spelling out what they are or who will suffer the cuts. That’s why IPAB isn’t even slated to come into existence until after the 2012 election. From Obama’s perspective, better to be criticized for not saving enough money than to acknowledge how deeply IPAB’s decisions will someday bite.
The bipartisan Simpson-Bowles deficit commission, appointed by Obama, essentially had no choice but to work within the framework of Obamacare. Accordingly, Simpson-Bowles pushed for IPAB to be granted a much wider range of powers, including the extension of its authority beyond Medicare to all of Obamacare. he’s already using the political cover provided by Simpson-Bowles to call for expanded IPAB authority. The literature on IPAB is filled with plans and suggestions for expanding its cost-cutting (i.e. rationing) powers.
A report by the Kaiser Family Foundation, beloved of liberal policy wonks, implicitly lays out a political route to a single-payer system: The report essentially agrees with conservative critics that IPAB’s price-setting will freeze Medicare recipients out of a great deal of care, but suggests that the solution is to place equal regulatory pressure on private payment rates.
A generation of retired baby boomers will be told that the only solution to their rationing problems is to bring even private health-care services under IPAB’s purview. Once this politically unaccountable panel has control of the entire health-care system, seniors on Medicare will gain at least somewhat greater access. In 2007, he made it clear that if he were designing a system from scratch, he’d opt for single-payer. Obama vehemently denied that his plan was a Trojan horse for a single-payer system. The Tea Party was inspired, in part, by a video clip in which Obama clearly implied a long-term goal of leveraging his plan into a single-payer system.
That free-market strategy has already had some success in the case of Medicare’s prescription-drug plan.
Obama’s plans depend on keeping IPAB as far under the radar as possible until after he has secured reelection in 2012.
IT’S THERE YOU’D BETTER WATCH OUT FOR IT
Source—weekly std, stan kurtz