The Defense for IPAB

Merrill Goozner

First published April 17, 2011 on GoozNews

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 code  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.

Merrill Goozner is an independent health care journalist who also maintains a blog at Gooz News.

One thought on “The Defense for IPAB

  1. Merrill -your last sentence is the key one – Ryan et al would ration by price, the other side by (hopefully) intelligent application of science.

    I’d note that Ryan and the GOP passed Part D – the single largest expansion of entitlement programs in fifty years – with little Democratic support, no funding, and no cost control.

    I’m waiting to see Wallace et al ask him about this…

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