I think the Independent Payment Advisory Board has a lot of promise as a way to control costs in Medicare. Perhaps more promise than anything else in the Affordable Care Act. But it won’t be easy:

Wanted: nationally known health care experts to serve on controversial health care board that will make painful Medicare spending cuts. Must be willing to quit current job to do it. Also, must be willing to go through bloody and humiliating confirmation fight.

That’s the job description for the 15 members of the Independent Payment Advisory Board — the new panel created by President Barack Obama’s health care law to come up with ways to cut Medicare spending if it grows too fast...The question that’s increasingly coming up in health policy circles, though, is: Who would want that job?

People often ask whether the Affordable Care Act can control costs. In a world where both parties want to use the Affordable Care Act as a vehicle for cost control, the answer is an unqualified “yes.” The law contains, in some form or another, just about every cost control idea on the table today, not to mention procedural reforms, like the Independent Payment Advisory Board, that could speed the introduction of cost control ideas we haven’t thought of. In a world where lawmakers want to control health-care costs, the Affordable Care Act more than empowers them to do so.

But in a world where one party is committed to sabotaging the Affordable Care Act and sees the inevitable pain of cost control as a continuous political opportunity? Where the nominees to the IPAB find themselves in procedural limbo, with the only respite being hostile interrogation that never results in confirmation because Republicans don’t want the IPAB to exist at all? That’s a world where the law limps along, protected from dying but prevented from thriving. And in that world, it very likely can’t control costs. The hope is that that world is temporary, and if Republicans fail to overturn the law in the next few years, they’ll eventually become more constructive participants in its success. But that’s a big “if.”