The Acronym That Ate Health Care
Meet IPAB, a constitutional outrage and de facto death panel


The 2012 election, and the existence of a free health-care market in this country, could well depend on a little-known agency called IPAB. Remember that acronym. It stands for the Independent Payment Advisory Board, a vastly powerful but too often overlooked component of the president’s health-care-reform law. IPAB has not yet come into existence, but when Obamacare goes into full effect, it will be an unelected and unaccountable bureaucratic entity with nearly limitless power over federal Medicare spending. IPAB will have the power to effectively ration health care through price controls — which may not even be the scariest thing about it. That distinction arguably falls to its unprecedented overriding of congressional sovereignty, in flagrant violation of the constitutional separation of powers.

President Obama won’t admit to any of this, of course, but his nationally televised April 13 speech in response to Paul Ryan’s deficit-reduction plan did push IPAB out of the shadows and into public view. Obama made clear in that speech that IPAB’s authority over Medicare pricing would be a central component of his deficit-reduction plan, and he used the occasion to call for a substantial expansion of IPAB’s already unprecedented powers.

For the GOP, that spells political opportunity. Obama can’t begin to match Ryan’s deficit-reduction program without massive, IPAB-imposed health-care controls that would amount to rationing. That means the best Republican defense against the inevitable avalanche of Democratic attacks on the Ryan plan is a good offense against IPAB.

The IPAB controversy raises anew longstanding concerns about President Obama’s political convictions and methods: his radicalism, ideological stealth, and long-term intentions. An emerging bipartisan movement to abolish IPAB highlights the fact that many moderate Democrats have been uncomfortable with this board from the start. IPAB’s central role in Obama’s plans suggests that, despite his denials, the president has never truly surrendered his aim of driving America toward a socialized, British-style single-payer model, in which our entire health-care system would be government-run.

While almost nothing about IPAB has been subject to public debate, almost everything about it should be controversial. Paul Ryan calls IPAB a “rationing board,” to which the White House replies that IPAB is specifically prohibited by law from rationing care. IPAB is indeed legally barred from formal rationing, but with its authority to control prices, it will be able to drive Medicare payments so low that doctors will simply stop offering key services to patients. In theory, Medicare would still pay for a whole range of tests and treatments, but in practice, patients solely dependent on Medicare would be barred from a great many of them. That is de facto rationing.

Of course, as with the Ryan plan, Medicare patients would still have the option of paying for non-reimbursed care out of pocket — that is, until IPAB helps usher us into a fully socialized single-payer health-care future (of which more below).

So is IPAB a “death panel”? Not exactly, at least in the sense of explicitly deciding who shall live and who shall die. Yet IPAB’s price-setting power gives it control over medical decisions now made by doctors with their patients. And, yes, that means rationing by unaccountable bureaucrats. The one-size-fits-all consequences of IPAB’s declarations will be final for many an unfortunate patient. In that sense, IPAB will indeed be a death panel.

No plan, least of all Obama’s, can offer a bottomless health-care purse to every American. The advantage of the Ryan plan, however, is its reliance on patient choice. Having been taxed throughout their working lives to support a system that offers no choice, Medicare-dependent patients lose control of funds they might otherwise have used to purchase private health insurance. Ryan’s plan returns some of that money to Americans via a tax-supported health-care voucher. This allows consumers to choose the private insurance plan that most closely matches their priorities — devoting more or less resources to end-of-life care, for example.


May 16, 2011    |     Volume LXIII, No. 9

Books, Arts & Manners
  • William Voegeli reviews The Origins of Political Order: From Prehuman Times to the French Revolution, by Francis Fukuyama.
  • Michael Knox Beran reviews Bismarck: A Life, by Jonathan Steinberg.
  • Robert VerBruggen reviews Selfish Reasons to Have More Kids: Why Being a Great Parent Is Less Work and More Fun Than You Think, by Bryan Caplan.
  • Jay Nordlinger on his friendship with the late composer Lee Hoiby.
  • Ross Douthat reviews The Conspirator.
  • John Derbyshire contemplates the fragility of civilization.
The Long View  .  .  .  .  .  .  .  .  
Athwart  .  .  .  .  .  .  .  .  
Poetry  .  .  .  .  .  .  .  .  
Happy Warrior  .  .  .  .  .  .  .  .