The House’s IPAB mistake


Congressional Republicans insist they’re deeply concerned about reducing health care costs and restraining spending, especially as it relates to the nation’s long-term fiscal challenges and the integrity of Medicare. It’s awfully difficult to take these concerns seriously in light of what we saw on the House floor yesterday.

In a rebuff to President Obama, the Republican-controlled House passed a bill on Thursday to abolish a Medicare cost control board created by the new health care law.

The bill, approved by a vote of 223 to 181, provoked a full-throated debate on the merits of the law, the Affordable Care Act, on the second anniversary of its signing by Mr. Obama.

At issue is a little something called the Independent Payment Advisory Board (IPAB), which as recently as yesterday, Fox News was still inexplicably referring to as “death panels.”

I can understand why the underlying idea is contentious, but the facts are pretty straightforward. As Paul Krugman explained a while back, “Arguably the most important thing we can do to limit the growth in health care costs is learning to say no; we cannot afford a system in which Medicare in particular will pay for anything, especially when that’s combined with an industry structure that gives providers a strong financial incentive to engage in excessive care.”

To address this, the Obama administration wants IPAB, as part of the Affordable Care Act, to make the difficult decisions, free of the political process on Capitol Hill, precisely because Congress has failed so spectacularly in its ability to make these choices on its own. The board, made up of experts who would require Senate confirmation, would get to work in 2014.

Yesterday’s vote was intended to make sure the cost-cutting panel never gets to work at all.

Why would Republicans say they want to lower costs and cut spending, then vote to kill a panel that would lower costs and cut spending? It has to do the GOP’s larger goal: scrapping Medicare altogether.

Both parties agree that Medicare faces long-term financial difficulties, and that addressing the problem is no easy task. Democrats have proposed measures like IPAB, which will limit unnecessary spending and lower overall Medicare costs, thus shoring up the program’s finances.

Republicans have an alternative proposal: scrap Medicare, starting handing out vouchers that won’t keep up with rising costs, and tell seniors to get sick less often.

Why would the GOP oppose a measure like IPAB? In large part, because they’re afraid the Democratic idea might work, and make the Republican goal of Medicare privatization that much less likely to happen. Since scrapping Medicare is the ultimate GOP goal anyway, IPAB’s efficacy would be a hindrance, not a benefit.

In other words, yesterday’s vote to eliminate IPAB before it starts makes clear that congressional Republicans place far more value in their ideological goal (end Medicare) than the practical goal (improve Medicare’s finances).

The measure now moves to the Senate, where Democrats have vowed to keep IPAB intact. Senate Republicans intend to push the House bill as an amendment to unrelated legislation, but if it somehow clears the chamber, a White House veto would be unavoidable.


The House's IPAB mistake