Reality-Based Economists Write on the Independent Payment Authorization Board
Alice Rivlin, Hank Aaron, Judy Feder, David Cutler, Harold Pollack, et al.:
We write with regard to the Independent Payment Advisory Board (IPAB), and the efforts by some in Congress to eliminate this body. We strongly oppose this effort, and encourage Congress to keep, and indeed strengthen, IPAB’s role.
The IPAB is a tool designed to help the Congress slow the rapid projected increases in health care costs in the federal budget and to improve the delivery of health care. Increases in Medicare, Medicaid and, the private sector could be slowed by giving providers greater incentives to adopt more cost-effective treatments and prevention interventions.
Public programs must be accountable to elected officials. However, to carry out its job effectively, Congress should mobilize the expertise of professionals who can assemble evidence on how payment incentives affect care delivery and suggest sensible improvements. The IPAB is constituted to make such professional expertise available to the Congress. Giving a body of experts the capacity to propose ways to slow spending growth will not diminish the power of elected officials, because Congress may approve, disapprove, or replace the IPAB’s proposals with alternatives that achieve the same objectives. Having the IPAB, however, will force debate on difficult choices that Congress has not thus far addressed.Professional judgment, grounded in evidence, is particularly important in an era where payment reform has become so critical to the quality of our health care and to our nation’s fiscal health. The Affordable Care Act sets up many demonstrations and pilot programs to learn how to structure payment to encourage more efficient delivery of quality care. As Medicare undertakes payment demonstrations and pilots, we must aggressively analyze their impact, replicate successes, and bring demonstrably better payment methods into national policy. To help accomplish these tasks, the Affordable Care Act established an independent, expert, evidence-driven body--the Independent Payment Advisory Board. Eliminating this board would severely hamper our ability to learn from experience, or to act on the lessons of experiments the Affordable Care Act seeks to promote.
We believe that an Independent Board is essential to promote, monitor and implement reforms that improve Medicare and the nation’s health care system. We urge Congress to act with this in mind.
I would like to add that this really should not be a partisan issue. If there is going to be a public insurance program, the least the public sector can do is run it well. Medicare is a public insurance program. IPAB--rather than leaving the setting of Medicare reimbursement policies in the hands of specialists on the one hand and overwhelmed legislators on the other--is a very important part of running the public insurance program well.
