Republicans are wrong on Obamacare, and they are hypocrites in the way they oppose the law. The House GOP’s latest budget is yet another example.
Republican opposition to Obamacare, at its core a centrist health-care reform, stepped out of the realm of the rational and into the realm of the theological long ago. One indication has been the hysteria over the law’s “death panels.” Experts and professional fact-checkers have debunked the notion that the Affordable Care Act would empower a faceless government board to deny critical health-care procedures, the Obama-era equivalent of pushing inconvenient seniors onto ice floes. But the GOP’s death-panel nonsense still has a hold on the party, its illogic written explicitly into the House’s budget.
“This budget repeals the Independent Payment Advisory Board (IPAB), an unelected, unaccountable board of 15 bureaucrats charged with making coverage decisions on Medicare,” the document reads.
Let’s translate that. If Medicare spending gets out of control, rapidly claiming more and more national wealth and robbing funding from other important priorities, Obamacare has charged a panel of experts, the IPAB, to step in and make recommendations about how to keep costs under control without affecting coverage or the quality of care. The point is to wring needless costs out of the program, not to deny important treatments. The board is hardly unaccountable: A supermajority in Congress can vote down IPAB recommendations. Lawmakers just can’t ignore them, which was the problem with IPAB’s utterly toothless predecessor, MedPAC. The IPAB arrangement is a modest cost-control measure that Republicans misconstrued into a dangerous health-care rationing regime years ago and continue to slander now.
Republicans should recognize how bad their repeal idea is. They claimed the mantle of fiscal responsibility during the Obama years, insisting that big entitlement programs such as Medicare need reform to forestall a painful fiscal reckoning. Their preferred reform is voucherizing Medicare, which is worth considering. But even in the system Republicans favor, one would still expect a debt-conscious Congress to demand oversight assuring that the massive amount of taxpayer money going to seniors’ health care isn’t squandered. Yet Republicans take pride in their proposal to destroy a board designed to do exactly that. At the least, one would expect a debt-conscious Congress to maintain the cost-control mechanisms already in place. But making IPAB a point of demagoguery instead is an easy way to make Obamacare seem to be the monstrous disaster it’s not.
If anything, IPAB should be given more power to assess the comparative effectiveness of various treatments — based on real data, not the political preferences of Congress — and to recommend Medicare payment standards that would make health care better, or that at least would achieve similar outcomes with less money. Instead, the board is limited to recommending broad payment and innovation policies
Republicans are right that Congress can’t sit back and assume that all the money the nation devotes to health care is spent wisely. They should act like they mean it.