The IPAB issue is beginning to get the attention it deserves. There’s a front-page story in today’s New York Times, a lead editorial at the Wall Street Journal, and a Dick Morris column, not to mention Rich’s column from yesterday. To repeat my point from “IPAB, Obama, and Socialism,” the best defense for the Ryan plan is a good offense against IPAB.
This is insane. The idea of IPAB is to CONTROL GOVERNMENT SPENDING and prevent TAX DOLLARS BEING WASTED. You know, exactly what we need.
We know that Medicare is not going to be abolished. So why the hell wouldn't we want to control its cost? Or is this some kind of Leninist "heighten the contradictions" tactic?
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Right, I really want 15 unelected bureaucrats making billions of dollars of decisions about medical procedures that affect thousands of lives from the air conditioned comfort of their offices. If we would just let the experts make these decisions, all of our problems would go away.
Reply to this commentLinkReport AbuseI feel like I've wandered into bizarro NRO. Here you have a plan to put stricter controls on a program that is supposed to be a safety net, and folks are lining up to say - no - do not under any circumstances try to make sure that the people's money is put to use efficiently and appropriately - just spend, spend, spend without control!
Reply to this commentLinkReport AbuseThe issue is not whether the costs of this entitlement program should be controlled. Obviously the expenditures have to be managed, as with any government program. The issue is WHO will manage these programs. We have 535 elected officials in that town whose responsibility is to manage the purse strings of our government. At least they are (in theory) answerable to their constituents, unlike nameless, faceless bureaucrats. If the program is too complex for our poor, overworked government officials to manage, then they shouldn't be in the business in the first place.
Reply to this commentLinkReport AbuseLot of talking past each other here. Remember, the IPAB won't being controlling the system's cost directly, only the amount the government spends. And the IPAB is nothing new, it's just a sort of doubling down on what we already have. You can read about MEDPAC here:
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Medicare has always had price controls, and has used them to keep prices below the rate of inflation.
Having recently retired from a career in health care finance, I've been watching the results for 40 years, nearly since the inception of Medicare.
Here's what I've seen in Medicare.
Enormous and growing waste. Read the latest GAO report:
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Lower rates, followed by higher activity, which leads to increased total spending, which leads to lower rates ....
So far the private side of things has been able to absorb Medicare's underpayment through a gigantic 'cost shift'. This is a driver of increased health insurance premiums that rarely, if ever, gets mentioned.
What do I predict with the IPAB:
An acceleration of past trends, until the system collapses. For a preview, check out Medi-Cal (what we call medicaid out here). A physician office visit pays $20. Where I worked, many docs would just see the patient for free, figuring the billing hassle wasn't worth it. At the hospital where I was the CFO we had to set up a system to pay specialists so they would follow up on Medi-Cal patients whose initial care took place in our emergency room. We are just at the price point where providers are going to walk away.
Price controls don't work. They have never worked. They never will work.
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