One of the most insidious aspects of Obamacare was the creation of the Independent Payment Advisory Board to control Medicare costs via virtual bureaucratic fiat, an issue I have inveighed against before. I enter the fray against the IPAB again in this week’s To The Source. Here is my conclusion to “Who Should Decide?”:
IPAB is anti democratic in that it removes lawmaking power from popularly elected officials to unelected and unaccountable bureaucrats. It already has the power to detrimentally impact the delivery of health care to Medicare recipients—say, by reducing compensation to doctors and hospitals, which could make it far more difficult for seniors to obtain care. Moreover, once cowardly politicians see that people will accept rule by bureaucrats, look for them to grant the IPAB even more muscular methods of cutting costs, such as the ability to ration care, perhaps even to altar benefits.
Worse, if Medicare costs can be controlled by bureaucratic fiat, why not delegate decision making about other volatile issues that cause politicians electoral headaches to all-powerful appointed boards of “experts?” In this sense, unless it is repealed or its powers reduced to the truly advisory, the IPAB could become the cornerstone of a new and democratically unaccountable bureaucratic state.
It would be disastrous if the USA devolved into a technocracy. Obamacare generally–and the IPAB specifically–have got to go.