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The Real Death Panel

The opinions expressed by columnists are their own and do not necessarily represent the views of

For a brief moment at the close of last year we were regrettably back to discussing ObamaCare’s fictionary “death panels”, the phrase Governor Sarah Palin coined to describe Medicare reimbursement of voluntary, end-of-life counseling.

After substantial outcry prevented the provision from being included in the health law, our rationer-in-chief, Center for Medicare and Medicaid Services Administrator Dr. Donald Berwick did an end-around the public and instituted it via regulation on December 3rd.

Thereupon, the false death panel charges reemerged in full force, until January 3rd, when the White House pulled the plug on the provision. No, not the plug on grandma---this time.

But don’t even think about releasing a big sigh of relief considering ObamaCare creates a very real death panel, the Independent Payment Advisory Board (IPAB) that will effectively pull the plug on countless grandparents. When leftists such as Peter Orzag and Ezra Klein describe IPAB as one of the law’s most important provisions, you know there is great reason to be scared.

IPAB’s 15-member panel of unelected, Senate-appointed bureaucrats is explicitly charged with making “recommendations to slow the growth in national health expenditures ... that the Secretary [of Health and Human Services] or other Federal agencies can implement administratively." Specifically, starting in 2015 their recommendations have to keep Medicare spending below a hard annual, per-capita cap dictated by an inflationary formula.

Congress has the power to vet their recommendations, but the law’s authors intentionally made sure the vetting structure isn’t very potent. For example, if Congress sits idly, IPAB’s recommendations automatically go into effect. Even if both houses of Congress say no to the recommendations, the President still has the power to issue a veto that, if not overturned, will also allow them to automatically go into effect.

Thus, if pro-ObamaCare Democrats control either the Presidency or just one body of Congress, the recommendations are virtually guaranteed to go into effect. I guess elections really do have consequences.

A critic might respond that the IPAB’s recommendations won’t be terribly objectionable given that their members will have to be appointed on a bi-partisan basis to get through the Senate. In fact, it wouldn’t be a shock if the bi-partisan board can’t agree upon any recommendations as a result of its members’ vastly different governing philosophies.

This scenario would render IPAB harmless indeed. If only ObamaCare’s authors didn’t account for this likely scenario. Unfortunately for seniors, they did---allowing radical Secretary of Health and Human Services to step in and issue equally binding recommendations.

You better believe we are living in the Age of the Bureaucrat. So what kind of recommendations should we expect from these unelected bureaucrats?

ObamaCare didn’t allocate IPAB with many tools in their toolset. As James Capretta at the Ethics and Public Center has astutely pointed out, they aren’t allowed to recommend patient cost-sharing for Medicare benefits or any other fundamental change to the entitlement. The only option members have is to cut reimbursement rates to providers.

Liberals such as prominent lawyer Timothy Jost have oddly argued that this doesn’t constitute rationing. I challenge them to tell that with a straight face to the Medicare enrollees that will be denied treatment because the program pays the provider insufficiently.

On average, Medicare only pays hospitals 71% and doctors 81% of private sector rates, often times below the cost of care. As a result, around 30% of doctors refuse to see the program’s enrollees entirely. Medicaid reimbursement rates are even lower, creating an even uglier disaster.

The tragedy of ObamaCare is that it mandates IPAB to institute further reimbursement cuts and thus guarantees higher denial rates. While government might not have specifically banned reimbursement for a treatment, the result is the same: denial of life-saving care.

IPAB’s heavy-handed role in this sad affair makes it, without question, the real ObamaCare death panel.

Considering the insolvency of Medicare and the budget-busting nature of Medicaid, the desire for cuts is expected. What’s reprehensible is the immoral, tyrannical manner of ObamaCare’s means to this end.

Thankfully, it doesn’t have to be this way. Congressman Paul Ryan has proposed transforming the Medicare into a voucher program that would empower seniors to control their own health care decisions. Sadly such a freedom-enhancing, consumer-driven proposal has little chance of being instituted while know-it-all statists still control the Presidency and Senate.

In the meantime, the Republican-controlled House of Representatives should make it a top priority to withhold the funding necessary to implement the Independent Payment Adviosry Board. Without this funding, it literally can’t exist and can’t impose any damage.

One more detail that should rev-up the de-funding juices---the 15 IPAB members will be paid $165,300 per year, almost three times the average household income of taxpayers paying for their rationing-services.

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