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IPAB: It's Patients Against Bureaucrats

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

This week the House of Representatives is scheduled to vote on one of the most damaging provisions of ObamaCare: The Independent Payment Advisory Board (IPAB). The board is supposed to be President Obama’s solution to Medicare’s funding crisis, yet it still leaves the program bankrupt in nine years. While Congressman Paul Ryan’s (R-WI) Medicare solution that saves the program from bankruptcy is well-known (and also misunderstood by most), IPAB has rarely been discussed, and thus the vote provides an important opportunity to educate the public about these two fundamentally opposite visions for Medicare’s future.

In Washington, politicians often give legislation a name that is completely contradictory to its function. One only has to look to ObamaCare’s real name “The Patient Protection and Affordable Care Act”, a law that makes health care more unaffordable and gives bureaucrats direction over patients’ care, to get the point. If IPAB was to spell out its true effect, it would be It’s Patients Against Bureaucrats.


The Independent Payment Advisory Board is in fact very independent, but there’s very little advisory about it. IPAB is a board of 15 unelected bureaucrats who are charged with keeping Medicare below a global spending cap. They are empowered with one tool and one tool only for meeting this target: cutting reimbursement rates. With 30% of doctors already limiting the number of Medicare patients they see, the fear is IPAB’s potentially dramatic reimbursements cuts will leave even more to stop seeing seniors.

In summary, ObamaCare creates a board of bureaucrats who are paid $160,000 a year, almost three times the annual wage of the average American, to hurt these very same Americans by limiting their access to necessary care.

Yes, IPAB technically submits to Congress its recommendations, which one can stretch to deem advisory, with specific provider rates that should be slashed. However, these recommendations automatically go into effect unless both the House and Senate pass legislation with an equal amount of reimbursement cuts and the President signs it into law. Let’s just say that’s highly unlikely and rather; it’s highly likely IPAB’s bureaucrats will singlehandedly control what services patients have access to. This pits patients against bureaucrats, giving IPAB its true name: It’s Patients Against Bureaucrats.

Thankfully, Congressman Ryan’s “Pathway to Prosperity” presents another vision for Medicare, one modeled on the Congressional health plan that independent polling consistently shows Americans think they should have access to. Well here’s their opportunity as Ryan’s reform provides future seniors with the same premium support that empowers them to choose among a wide variety of Medicare-sponsored health policies and select the one that fits their needs and their desires.

When voters are presented with the choice of these two futures, one where patients choose their own health care or one where bureaucrats choose their health care, which choice do you think they will make?

Of course the vast majority will choose the former and thus, that’s how Republicans must contrast the two Medicare reform plans if they wish to win the day, a fight they are presently losing.

Critically, this same debate extends beyond IPAB and is at the crux of almost all of our debates today: will we have a future where people control their own lives or have one where government bureaucrats do. Most notably, it’s also seen in the other ObamaCare debate over whether government should be able to force Americans to violate their conscience by mandating the purchase of products they are morally opposed to. This November, the American people will have an opportunity to determine whether to continue down the latter road or turn on down to the former. Let’s hope they make the right choice.

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