The Defense for IPAB

April 17, 2011
By

Sen. Tom Coburn (R-Okla.) and Rep. Chris Van Hollen (D-Md.) squared off on Fox News Sunday over the best way to hold down medical costs in the years ahead. Coburn, a physician, focused exclusively on public programs like Medicare and Medicaid, and hewed to the new Republican extremist position that favors privatization and higher individual payments. “Until we reconnect payment with purchase, you can’t fix it,” he said. “There’s no way the government is going to drive down costs without rationing.”

Host Chris Wallace honed in on that point when he turned to Van Hollen by attacking the Independent Payments Advisory Board set up by the health care reform law. Typical of the rightward slant of the program, he asked if Democrats really believed a government panel of “experts” — said with a sneer — could do a better job than the market.

Van Hollen badly fumbled his response. He started by explaining that Medicare isn’t the whole health care system, and then said the best way to hold down costs was to hold down costs in the entire system through the Affordable Care Act. Then he retreated to the stock Democratic line that Medicare was created precisely because when it came to insuring seniors, “private insurance companies would not do it.” Even to this wonk, he response was barely coherent.

Moreover, he never responded to Wallace’s question, which most viewers would get right away. So listen up all Democrats. Here’s my talking point if you’re asked the “do you want government experts” dictating your health care choices question (which is codeĀ  for the IPAB set up under the health care reform law):

Far better to have a government panel made up of representatives of every constituency involved in health — hospitals, doctors, drug and device companies, patients AND consumers — which the law says must come up with its proposals in public session, which are then submitted to Congress for a yes or down vote; than to have insurance companies make those decisions using their own so-called expert panels, which will be made up of insurance company executives and the doctors they hire; whose deliberations will be conducted in secret; and whose decisions will be made without any public input and without public recourse — except protest — if you don’t like the decisions they impose.

(If you have additional time): By the way, that’s what happened the last time we completely turned over decision-making to the insurance industry. Remember the late 1990s and HMOs? They cut access to health care indiscriminately, which led to massive public protests because of their poor choices in denying care. When Congress almost passed a patients bill of rights, the insurance industry gave up trying to control costs and simply passed along every price increase. That created the near disastrous situation we face today in terms of escalating costs in private insurance plans, just as we have unacceptably high increases in our public programs.

Everyone says we have to cut spending on health. I’ll take a public board with transparency and public accountability every time over turning those decisions over to a private insurance company whose sole motivation is increasing its bottom line. You say Democrats are for rationing? The people opposed to health care reform are the real rationers. Only they would ration by price, not by publicly accountable boards making science-based decisions to not pay for ineffective, costly care.

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2 Responses to The Defense for IPAB

  1. Emily on April 18, 2011 at 4:47 pm

    Payment with purchase? Is Coburn kidding? A lot of reform would have to happen before people had easy access to that information. It’s not easy to be an informed patient when it comes to costs. For example, I thought it would be safe to assume that a visit to the ER for my 2 year old for a fall would have been more expensive that the vacation visit to an urgent care center for my husband’s sore throat. Nope. It was the other way around. Incidentally, I asked the billing person what the cost of an ER visit was when my son was in there. She works there every single day and she had no idea. Besides, it’s not like by in large you can shop around for a different health care need as in you need a blood test, but decide to buy a strep test because that’s a better price.

  2. Steven Findlay on April 19, 2011 at 7:55 am

    Agree with your points Merrill. But IPAB as currently structured in the ACA is quite weak. The President last week proposed strengthening it but we have no details on how yet. In principle, strengthening it is a good idea; it should have had more authority to begin with. But politically, in the current environment, that change in the ACA would be a very heavy lift.

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