One of the funny things about congressional Republicans and health care policy is the extent to which they set clear goals and then oppose efforts to reach those goals. For example, GOP leaders want Democrats to accept policies that curtail Medicare costs, and then try to sabotage Democratic efforts to curtail Medicare costs.
In a largely symbolic move, Republican leaders in Congress told President Barack Obama on Thursday that they will not participate in picking members of a controversial healthcare panel intended to restrain cost growth in the Medicare health insurance program for the elderly and disabled.House of Representatives Speaker John Boehner and Senate Republican leader Mitch McConnell informed the president in a May 9 letter that they will not recommend appointments to the 15-member Independent Payment Advisory Board, or IPAB, and want the panel repealed instead.
The entirety of their letter is online (pdf).
I realize IPAB may seem like a relatively obscure part of the larger health care law, so in case anyone needs a refresher, let's quickly recap.
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."
As we discussed in June, the Obama administration seeks to solve this problem through IPAB -- putting the difficult decisions in the hands of qualified medical and health care professionals, free of the political process on Capitol Hill. And why is this necessary? In large part because Congress has failed so spectacularly in its ability to make these choices on its own.
In theory, Republicans should be delighted -- we're talking about a panel tasked with cutting entitlement spending and saving money. Indeed, it was rather gracious of the White House to reach out to GOP leaders to ask them to recommend officials to serve on the board.
The surface-level problem, however, is Republicans say they want to lower costs and cut spending, but also oppose a panel that would lower costs and cut spending. And the deeper problem is that they hope to sabotage IPAB because they prefer an alternative approach.
In terms of fiscal goals, both parties want roughly the same thing: a more stable fiscal future for health care costs, especially for seniors. Democrats see value in IPAB, and there's ample reason to believe this is a responsible approach. Republicans, meanwhile, argue that Medicare should be eliminated, and replaced with a voucher program in which seniors effectively bring a coupon to the private insurance marketplace. This, too, would lower costs by shifting the financial burden from Medicare to financially vulnerable families.
And why do Republicans hate IPAB so intensely? Largely because they're afraid it might work -- if IPAB lowers costs and cuts spending, there won't be any reason to listen to far-right lawmakers demanding the elimination of Medicare altogether.
So, Boehner and McConnell have come up with a plan, and it goes like this: if they can stop IPAB, they can prevent the panel from doing worthwhile work. And if IPAB is unable to lower costs, Medicare will become more fiscally unstable in the coming years. And if Medicare's finances worsen, Republicans will have a stronger hand when they say they want to kill the Medicare program and privatize it out of existence.
Remember, for GOP lawmakers, the goal is not to solve a problem. Rather, the goal is to advance an ideological agenda that calls for slashing public investments and shrinking government, regardless of the consequences.
IPAB may be a relatively obscure element of the larger health care policy, but Republicans have prioritized its destruction because it's key to the larger effort.