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I warned in the Weekly Standard that the new Medicare Independent Payment Advisory Board is the cornerstone for a new bureaucratic state.  From my piece “Our New Obamacare Masters:”

At present, Congress is responsible for setting the policies that govern all aspects of Medicare, including payments to health care providers and facilities. That  arrangement is inevitably messy because the people have a strong say.  The creators of Obamacare saw the ability of constituents to influence their representatives as a problem. Saying, in effect, “Stop us before we spend again,” Democrats transferred most of Congress and the president’s policy-making authority to the 15 “expert” members of the Independent Payment Advisory Board, appointed by the president and confirmed by the Senate. If this board determines that the growth of Medicare costs will exceed a predetermined target, it has the power to enact a remedy through “fast track” legislation...

The secretary of health and human services must implement the Independent Payment Advisory Board’s proposal, as passed by Congress and signed by the president, on August 15 of the year in which the proposal is submitted. If Congress does not pass the proposal or a substitute plan meeting the Independent Payment Advisory Board’s financial target before August?15, or if the president vetoes the proposal passed by Congress, the original Independent Payment Advisory Board recommendations automatically take effect.

Defenders of the IPAB concept assured us not to worry because the commission currently has no power to ration care or change benefits.  But as I noted:
That is hardly reassuring. Legislators love to abdicate responsibility as a way of protecting their political behinds. If this transfer of limited authority to a faceless board goes down smoothly, what’s to stop Congress from expanding the board’s authority, allowing it to make more substantive changes in Medicare by bureaucratic fiat? Think of all the questions legislators could sidestep at town hall meetings by pointing an accusatory finger at the board!

Now, only a few months later—that is precisely what the president is proposing! And the IPAB isn’t even appointed or up and running yet.  From a White House Fact Sheet issued in the wake of his speech yesterday on the deficit:

  • The President’s framework will strengthen IPAB to act as a backstop to the other Medicare reforms by ensuring that Medicare spending growth does not outpace our ability to pay for it over the long run, while improving the program and keeping Medicare beneficiaries’ premium growth under control. Specifically, it would:

  • Set a new target of Medicare growth per beneficiary growing with GDP per capita plus 0.5 percent. This is consistent both with the reductions in projected Medicare spending since the Affordable Care Act was passed and the additional reforms the President is proposing.

  • Give IPAB additional tools to improve the quality of care while reducing costs, including allowing it to promote value-based benefit designs that promote proven services like prevention without shifting costs to seniors.

Hmm. Giving IPAB “additional tools” than it has now “to improve the quality of care while reducing costs” including  promoting “value-based benefit designs,” would sure seem to be a major expansion of its power—perhaps including rationing and unilaterally imposed benefit changes.  And this before it even got off the ground.

I told you so.


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