— Rep. Phil Gingrey (R-Ga.), June 22, 2011
The body count in the war between Democrats and Republicans over Medicare continues to mount.
First, Health and Human Service Secretary Kathleen Sebilius said that cancer patients would “die sooner” under the House Republican Medicare proposal. (She earned Three Pinocchios for that statement.) Now, Rep. Phil Gingrey has charged that a provision in the Obama health-care law — the creation of an Independent Payment Advisory Board — will lead to the death of people on dialysis or cancer chemotherapy because of “rationing” by “bureaucrats.”
Who knew that politicians on each side were so determined to let people die? (We embed the notorious “Granny off the cliff” ad at the end of this column.) Turning the tables on Democrats who claim the GOP plan would “kill Medicare,” Gingrey said that by supporting the IPAB, “President Obama has already ended Medicare as we know it.”
Rhetoric aside, Gingrey’s comment seems like an opportune time to try to examine this mysterious entity and what it is intended to do. Many senior Republican lawmakers have complained about it, and we imagine it will be featured in future presidential debates.
Beginning in 2014, the 15-member IPAB (made up of experts subject to Senate confirmation) is designed to help reduce the rate of growth in Medicare spending if it exceeds a certain target rate. The board would make recommendations to reduce costs.
Then, beginning in 2018, if the targets are not met, the board will submit a plan to the White House and Congress to achieve the necessary cuts. Congress could pass a different set of cuts or reject the IPAB recommendations with a three-fifths vote in the Senate.
In effect, the IPAB appears designed to mimic the Defense Base Realignment and Closure Commission, which was designed in the late 1980s by then Rep. Dick Armey (R-Tex.) with the backing of the Reagan administration. That commission was empowered to make politically difficult decisions of closing military bases, thus limiting the influence of lobbyists and in effect letting Congress off the hook of making the tough decisions themselves. It is generally considered a great success.
The health-care law, by the way, explicitly says that the recommendations cannot lead to rationing of health care. (Page 428 of the PDF.) Of course, “rationing” is in the eye of beholder. The law also limits recommendations that would change benefits, modify eligibility or increase Medicare beneficiary cost-sharing, such as deductibles, coinsurance and co-payments.
On the surface, the IPAB appears aimed at doing the same thing as the House Republican Medicare plan – reducing the runaway costs of Medicare, except on a faster track. (The GOP plan would not kick in until 2021, just a few years before the Medicare hospital fund begins to run dry.)
The dispute really centers on a philosophical divide between the parties. Democrats would rely on independent experts (such as doctors and consumer advocates) to recommend the cuts; Republicans would rely on the insurance marketplace to control costs. We can’t fact check deeply held philosophical beliefs, except to note that such differences sometimes loom larger than they really are and prevent people from acknowledging obvious similarities.
In fact, when the conservative National Review this month called for the repeal of IPAB, one of its frequent contributors objected. “Medicare costs are expected to continue to explode over the next several decades, swallowing an ever larger share of federal revenues,” wrote Josh Barro, an expert on fiscal issues at the Manhattan Institute. “We must control those costs. If not through IPAB, then how?”
Barro added: “The only ways to save money in traditional Medicare are to pay less for things or to pay for fewer things; which is to say, you can only hit that target if you have IPAB or something that looks an awful lot like IPAB.”
Interestingly, Gingrey’s staff refused to defend the lawmaker with an on-the-record statement. A congressional aide, speaking on condition of anonymity, said that the problem is that the Obama health law does not define rationing.
“Not rationing can mean that a senior with a broken leg gets a splint and not a cast, or painkillers instead of a kidney transplant. Giving a cancer patient a shot of morphine to treat the pain is not the kind of quality health care our seniors have come to depend upon,” the aide explained. “The lack of a definition of a word within a law could ultimately lead to the death of a patient who was denied a particular treatment because his or her doctor couldn’t afford to give it to them.”
The Pinocchio Test
We can certainly understand that Gingrey may have philosophical concerns over the IPAB, but that does not excuse his leap of logic that it will lead to the deaths of seniors. Even with the potentially vague language on rationing in the law, the board members would need to be confirmed by the Senate, and Congress would have the opportunity to reject the recommendations. Both parties profess to be concerned about the rising costs of Medicare, so it would be better to dwell on the potential areas of agreement rather than exaggerate differences.