In IPAB, 'independent' means unaccountable

As lawmakers and patients learn what the Affordable Care Act's (ACA) Independent Payment Advisory Board (IPAB) really will mean for seniors, the topic has become a contentious one across the country.

IPAB is a 15-member panel of unelected and unaccountable bureaucrats responsible for making recommendations to cut Medicare costs in years when spending exceeds targeted growth rates. Congress has given a small group the power to make decisions by majority vote with only the necessity that a quorum of 8 be present. This panel has, in essence, eternal life, and can determine what funding is given to pay for medical care.  The law says no rationing but cutting off funds can have the same effect and stifle innovation. 

Physicians well remember Section 1801 in the original Medicare law that said no federal interference in the practice of medicine. That turned out to be a cruel joke. IPAB’s cuts are expected to, at the least, exacerbate the shortage of doctors who see Medicare patients — a problem that already has made it difficult for thousands of patients across the country to get the care they need, when they need it. IPAB follows the path of the failed Sustainable Growth Rate Formula (SGR) except it has more power and difficult for Congress to reverse.

But IPAB’s cuts could come in a form far more hurtful to patients: It has the power to bring about rationing by cutting the payment for medical services to a point where access to care is jeopardized. In effect, that power is equivalent to health care rationing. The board will have the power to prevent Medicare from covering certain treatments, leaving many patients who require those treatments unable to afford the care they need.

IPAB’s role in the United States would be eerily reminiscent of the National Institute for Clinical Excellence’s (NICE) role in Great Britain, where NICE makes recommendations to Britain’s National Health Service (NHS) on what they should and shouldn’t cover. NHS then rations care accordingly. Unsurprisingly, the system has turned substandard health care into a way of life for millions of patients in Great Britain, causing some to travel to the United States to get the care they need.

Additionally, the notion of IPAB being an “advisory board” that makes “recommendations” on cost cutting is a misleading one. The Department of Health and Human Services (HHS) is required to implement IPAB’s proposals unless a supermajority of Congress adopts measures that cut the same amount of costs. What did lawmakers include IPAB in the health reform law in the first place?  To abdicate responsibility for making painful cuts to Medicare, and instead place the burden on the shoulders of bureaucrats who are more concerned with cutting costs than helping patients? It is doubtful that Congress would act as a check to IPAB in any significant way. In IPAB’s case, independence means that lawmakers are free from having to answer to seniors who expect and deserve quality health care.

It is clear that IPAB, in reality, has become President Obama’s preferred tool for controlling Medicare costs. In fact, the president recently called for a stronger IPAB. But while all agree that Medicare needs reform, it is equally clear that a reckless, unaccountable cost cutting board with virtually no Congressional oversight is not in seniors’ best interests. Additionally, as proven by the recent letter sent by 270 health care stakeholder groups to Congress calling for IPAB’s repeal and the American Medical Association’s recent resolution calling for the board’s elimination, this opinion is strongly supported by the medical community. 

Yes, Former Speaker Nancy Pelosi (D-Calif.), you said we had to pass this law so we could find out what is in it. Now, in the aftermath of the bill you rushed through Congress, Americans know what is in it and they don’t like it.

Saving Medicare for our nation’s seniors should, in fact, be an issue that transcends politics. But an unaccountable rationing board made up of cost-cutting bureaucrats is not the answer. Let’s hope our lawmakers work in the best interest of patients and repeal IPAB before it gets a chance to start harming the quality of care available to seniors in the United States.

Donald J. Palmisano, M.D. is the former president of the American Medical Association and current spokesperson for the Coalition to Protect Patients’ Rights.