From the pages of the Des Moines Resister.
(Why Iowa? You know why.)
Our shortsighted plan for dealing with Medicare
By: Peter J. Pitts
First, HHS announced it would be making $42 million available to enhance coordination efforts between primary care physicians and other health care providers treating Medicare patients. An Emory University study concluded that better coordination in Medicare could save $125 billion over the next 10 years.
Second, HHS launched a $40 million effort to help states combat chronic disease.
Chronic diseases are responsible for 75 percent of our health care costs. Diabetes, heart disease and strokes alone account for nearly a trillion dollars in medical spending annually.
Both those initiatives have the promise to save money and lives. Unfortunately, they represent exactly the opposite approach to Medicare cost control set forth in last year's health care reform law.
Deep in the heart of the 2,700-page law is the creation of something called the Independent Payment Advisory Board (IPAB), a panel tasked with reining in soaring Medicare costs.
Here's how IPAB will work. The president will appoint 15 "experts" to serve on the board. Starting in 2014, they will be charged with keeping Medicare annual spending in line with designated targets. Any time spending looks to exceed its target, IPAB must draw up cuts to bring it in line.
Incredibly, IPAB's Medicare spending recommendations automatically become law whether a majority of Congress approves of them or not. Overriding IPAB requires a three-fifths majority vote in the Senate, a very high legislative hurdle. There's also no way for doctors or patients to legally or administratively challenge IPAB's decisions.
There are numerous legal problems with IPAB. A lawsuit is challenging the board's constitutionality, arguing that it has been improperly delegated authority over the federal budget (about 13 percent of the total) that constitutionally belongs to Congress.
The policy repercussions of IPAB are even worse. In meeting its spending targets, IPAB is ostensibly not permitted to ration care or adjust Medicare premiums and fees. Its main tool for cost-cutting is to lower Medicare reimbursement rates to doctors and other health care providers.
Unfortunately for Medicare patients, reimbursement rates are already well below market rates. Because of this, the number of doctors limiting or refusing Medicare patients is at an all-time high. IPAB threatens to make doctor access a major problem for Medicare.
Worse still, the scramble IPAB will produce each year to meet spending targets will deflect policymakers' attention from innovative new programs such as the two announced by HHS.
Even though the HHS primary care coordination and chronic disease initiatives are comparatively inexpensive and could eventually yield major savings, it will likely take years to measure their impact, let alone demonstrate that they're reducing costs. Not only that, they increase health care costs in the short-term.
On one hand, these two new HHS initiatives show that the Obama administration is making credible efforts to target the areas of the health care system that could produce the most savings. On the other hand, the Affordable Care Act through IPAB seeks to devalue efforts such as these in favor of squeezing doctors and other providers.
The right way forward is to get rid of IPAB and substitute for it a Medicare cost-savings plan that encourages long-term strategic thinking along the lines of these HHS studies.
The partisan acrimony over health care reform in Washington would seem to make all-new Medicare legislation unlikely. Fortuitously, though, bipartisan concern about IPAB's obvious shortcomings might prove to be the catalyst for a new and improved reform initiative.
House Budget Chairman Paul Ryan, R-Wis., has made repealing IPAB a major part of his high-profile budget proposal. Politico reports that several House Democrats have signed on to repeal IPAB. The repeal legislation's House sponsor, Phil Roe, R-Tenn., has floated the possibility of attaching repeal to the must-pass increase in the debt ceiling.
Support for IPAB is rapidly and rightly collapsing as citizens become better informed about the danger this all-powerful panel of unelected bureaucrats poses to their health care. It's time to urge Congress to get rid of IPAB and stand up for real Medicare reform.
