Wrong way on health care

Monday, August 16, 2010

ONE OF THE most promising aspects of the new health-care reform is the creation of an independent board to recommend changes in federal health programs and a fast-track provision that would allow these changes to take effect automatically unless Congress comes up with alternatives that would save a similar amount. There are legitimate concerns about the new Independent Payment Advisory Board, but these involve whether its mandate is broad enough -- it can't change eligibility rules, modify benefits or, until 2020, recommend changes in hospital payments -- and whether its savings targets, especially in later years, are achievable.

Unfortunately, even if predictably, the pressure in Congress seems to be in the other direction. A group of Republican senators -- 12 at last count -- led by Texan John Cornyn has introduced the ominously titled Health Care Bureaucrats Elimination Act. It would eliminate IPAB even before the panel comes into existence in 2014. Its text occupies a single page repealing the relevant provisions. Section 2 is titled, "Removal of Unelected, Unaccountable Bureaucrats from Seniors' Personal Health Decisions by Repealing the Independent Payment Advisory Board."

As Mr. Cornyn thundered in a statement, "America's seniors deserve the ability to hold elected officials accountable for the decisions that affect their Medicare, but IPAB would take that away from seniors and put power in the hands of politically appointed Washington bureaucrats." This scare tactic may make for good politics -- remember death panels? -- but it is bad policy. Lawmakers are happy to proclaim the importance of fiscal discipline and the need to get health costs under control. But they balk at taking particular steps to make that happen, especially when those steps discomfit, as they inevitably will, one special interest or another. If you doubt that, compare the recommendations of IPAB's predecessor, the Medicare Payment Advisory Board, with what Congress ultimately chose to implement.

The political system failed when it came to controlling health-care costs. The 15-member panel that Mr. Cornyn et al. deride as "beltway bureaucrats" would be a group of experts in the field, nominated by the president, chosen in part by congressional leaders of the opposing party and subject to Senate confirmation. Congress isn't bound by its proposals if lawmakers can come up with what they think is a better approach. Getting costs under control is going to require difficult choices -- including, in the case of Medicare, difficult political choices. This unwise bill is not a good sign about Washington's willingness to make them.

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