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Abolish IPAB
We shouldn’t let unelected bureaucrats ration health care.


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The latest Medicare trustees’ report [pdf] estimates Medicare will go bankrupt by 2024, which is five years earlier than last year’s estimate. This news is a threat to senior care, and at this rate, Medicare will not be available for future generations. However, since we know the problem is coming, we can act now to save Medicare, improve the quality of care, and keep Washington bureaucrats out of patients’ medical decisions.

But fixing Medicare should not compromise patient care, and that is what President Obama’s solution would do. The president’s health-care bill created the controversial Independent Payment Advisory Board (IPAB), a board of unelected bureaucrats whose sole purpose is to decide based on a budget whether to offer Medicare benefits, which leads to rationing of care by government officials. With Medicare’s outlook worsening, the president is now trying to double down on his health-care plan and allow the board to ration even more care.

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IPAB shifts health-care decision-making power away from the patient; it will operate without transparency or accountability, bypassing all congressional oversight; and it places the focus on slashing Medicare costs, rather than on improving the quality of care.

The board will consist of a group of 15 unelected bureaucrats who will decide what constitutes “necessary care.” IPAB will try to create a “one size fits all” solution when it comes to medical care. As a physician, I can tell you firsthand how dangerous this mindset can be. In medicine, every case is unique and must be treated that way.

Even more worrying, the board’s recommendations can set Medicare policies without any transparency, oversight, or debate. If Congress fails to change IPAB’s recommendations, they go into effect, and it’s important to note that Congress can only change where to cut — it cannot decide that cuts are too drastic. This could lead to denial of care.

For comparison, consider what has happened with Medicare physician payments. In 1997, Congress enacted a formula called the sustainable growth rate to set physician payments under Medicare. The formula works similarly to IPAB: If physician payments exceed a targeted spending level, the per-procedure payment is cut to bring spending levels back in line with the target. When it was created, it was believed the formula would help ensure that physicians would continue to see adequate payment for their work, because they could simply do more procedures. Instead, physicians have gotten a decade-plus of proposed cuts that they have had to ask Congress to stave off. Recently, a 21 percent cut went into effect for just less than a month, so these cuts aren’t an idle threat.

IPAB would also effectively eliminate Congress’s ability to work with the Centers for Medicare and Medicaid Services (CMS) to create and implement demonstration and pilot projects designed to evaluate new and advanced polices such as home care for the elderly, the patient-centered medical home, new and less invasive surgical procedures, collaborative efforts between hospitals and physicians, and programs designed to eliminate fraud and abuse.

The United Kingdom’s National Health Service has a comparable board called the National Institute for Health and Clinical Excellence (NICE); President Obama borrowed from the NICE model when creating IPAB. Recently, NICE denied the use of several new drugs to NHS patients with chronic leukemia. The NICE board’s reasoning for the decision: “When we recommend the use of very expensive treatments, we need to be confident that they bring sufficient benefit to justify their cost.”

While the president claims his board will help reduce the deficit, the latest decision by NICE in Britain illustrates the likely way such deficit savings will be achieved: rationing your care. It’s easy for a board to deny funding for care, but what if you’re the patient with leukemia, or a doctor trying to offer the best care? NICE’s decision completely ignores quality of care if the treatment is deemed too expensive by the board’s standard. Decisions like these are exactly what IPAB will have the authority to make, and this simply cannot be allowed to happen.

The good news is that under current law, the Congressional Budget Office has indicated that the board won’t yield any savings over the next ten years. But that will surely change if the president has his way. I have introduced bipartisan legislation to abolish IPAB, with over 120 cosponsors to date. By passing our bill, Democrats and Republicans can say with a unified voice that the idea of charging unelected bureaucrats with patient-care decisions is unacceptable, and we must preserve Medicare by giving patients the power to control their health care.

Rep. Phil Roe is a congressman from Tennessee.



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