RomneyCare Aftermath: The Tunnel at the End of the Tunnel: IPAB Edition
Medicare is such a large component of our health care system--and growing larger. So whatever treatment protocols and practices are used on Medicare patients is likely to drive costs and utilization throughout the whole American health are system.
And the IPAB is supposed to drive those--and save us $2 trillion over the next twenty years without harming the quality of care. It's a very big job. It's very important that it be done right.
Ezra Klein muses:
Can we control costs without Congress?: It is a sad commentary on Congress that the most promising cost control in the Affordable Care Act is the one that takes much of the responsibility for controlling costs away from Congress and hands it off to an independent board of experts. That board... has made it... and in substantially stronger form than I, for one, expected... a strong version of IPAB slipped through almost unnoticed... a 15-person, full-time board composed of health-care experts and stakeholders. Members need to be confirmed by the Senate and will serve six-year terms, with one possible reappointment. But the important thing isn't who serves. It's how they vote. Or, as the case may be, don't vote. If Congress approves the board's recommendations and the president signs them, they go into effect. If Congress does not vote on the board's recommendations, they still go into effect. If Congress votes against the board's recommendations but the president vetoes and Congress can't find the two-thirds necessary to overturn the veto, the recommendations go into effect. It's only if Congress votes them down and the president agrees that the recommendations die. “I believe this commission is the largest yielding of sovereignty from the Congress since the creation of the Federal Reserve,” says Peter Orszag, who's been one of the idea's most enthusiastic supporters.
The board will propose packages of reforms that bring Medicare in line with certain spending targets. Those reforms won't increase cost sharing or taxes and they won't change eligibility or benefits. Instead, they're reforms of what Medicare pays for and how it pays for it.... Nevertheless, this is the most powerful cost-cutting agency we've seen. For all those folks saying Congress can't stick to cuts, this is the closest thing to a solution that anyone's come up with. It gives Congress a way to let someone else take on the hard decisions that it doesn't have the expertise or political will to make. If Congress so chooses, it could let the IPAB do its work without ever bringing the recommendations up for a vote: They'd still go into effect, and no one would be on the record in either direction.
As a commentary on Congress, is all this a bit sad, and even weird? Yes. But it may also be necessary.... The bottom line is that IPAB creates a continuous system for controlling costs in Medicare and trying out new reforms and experiments. For all those disappointed by Congress's fecklessness when it came to cost controls in the Affordable Care Act, know that Congress actually agrees with you, and is trying to do something about it. Or at least let someone else do something about it.
Peter Orszag definitely needs message discipliine. He should not say "largest yielding of sovereignty from the Congress." Scalia, Alito, Thomas, and Roberts may pick this up and try to cause trouble--not for any principled commitment, you understand, but just because they can and they feel like it.
