In a health-care bill that was mostly about extending benefits to uninsured Americans, the IPAB was one of the few checks on how much national wealth would go to the inefficient health-care industry. If Medicare spending growth breached relatively generous targets, the expert panel would recommend money-saving payment reforms — though it could not ration care, increase premiums or eliminate benefits. The board’s recommendations would automatically phase in unless Congress objected. If anything, the law limited the experts too much.
But responsibility is hard to sell. Though President Barack Obama and his staff defended this mechanism, they flinched at the prospects of cuts on his watch, scheduling the board to begin its work, if necessary, after he was reelected. Meanwhile, the board became a target for demagogues. In their effort to whip up hysteria over the law’s supposed “government takeover” of health care, Republicans ludicrously insisted that the IPAB was a “death panel.” When that didn’t kill it off, the health-care industry took over, spending millions over the years on television ads and other campaigns to kill the IPAB. Every bit of waste is some companies’ profit, and the industry wasn’t going to let it go without a fight — though of course it pretended to be fighting on behalf of patients.
Industry opposition, anti-Obamacare activism and lawmakers’ fear of being seen as cutting Medicare succored a bipartisan push to stymie the IPAB. The board was starved of funding, and no members were ever appointed; it remained a check in theory but not in practice. For now, this was not a dire problem, because health-care spending growth had not breached IPAB targets.
But if health spending once again gets out of hand, the IPAB mechanism would have compelled at least modest savings. Now that protection will be gone. The health-care industry, given useful cover by anti-government demagogues, can celebrate. The rest of us, one way or another, will pay.
Between the latest budget deal and the Republicans’ tax bill, Congress has decided to balloon deficits in the midst of a brisk economy — just when the government should be saving money for harder times. Those days will come as the baby boomers retire, health care becomes ever more expensive, debt service costs expand and future generations struggle to finance it all. Killing off the IPAB is another marker of this irresponsibility.
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