Since the Obamacare debate began in 2009, conservatives have warned that the law's Independent Payment Advisory Board (IPAB) is an unaccountable government panel that will ration care in order to cut costs. The administration dismissed these "smears," refusing to even acknowledge the possibility of rationing, even as the president made illuminating comments like this. Five years later, former DNC Chairman and firebrand presidential candidate Howard Dean is conceding that Obamacare critics were right all along on several key points. From his Wall Street Journal op/ed:
One major problem is the so-called Independent Payment Advisory Board. The IPAB is essentially a health-care rationing body. By setting doctor reimbursement rates for Medicare and determining which procedures and drugs will be covered and at what price, the IPAB will be able to stop certain treatments its members do not favor by simply setting rates to levels where no doctor or hospital will perform them. There does have to be control of costs in our health-care system. However, rate setting—the essential mechanism of the IPAB—has a 40-year track record of failure. What ends up happening in these schemes (which many states including my home state of Vermont have implemented with virtually no long-term effect on costs) is that patients and physicians get aggravated because bureaucrats in either the private or public sector are making medical decisions without knowing the patients. Most important, once again, these kinds of schemes do not control costs. The medical system simply becomes more bureaucratic. The nonpartisan Congressional Budget Office has indicated that the IPAB, in its current form, won't save a single dime before 2021. As everyone in Washington knows, but less frequently admits, CBO projections of any kind—past five years or so—are really just speculation. I believe the IPAB will never control costs based on the long record of previous attempts in many of the states, including my own state of Vermont.
Right on all counts, doctor, at least in the excerpt above. Remember, too, that IPAB's rationing savings were earmarked to pay for Obamacare and extend the solvency of Medicare. This impossible double-counting was one of the worst accounting gimmicks employed to dishonestly conceal the true cost of the law. What's puzzling about this piece is that Dean is an advocate for even greater government control of healthcare, via a single-payer system. Guess what such systems lean on to keep the spiraling costs associated with "free" healthcare somewhat in check? Severe, and often cruel, centralized rationing. Still, it's remarkable that Obamacare has now faced searing criticism over the last few weeks from both Howard Dean and major labor unions, as self-identified moderate and conservative Democrats are backing away from the law. The reasons behind this latest wave of opposition are ubiquitous. A few new additions to the long list: (1) The liberal, generally pro-Obamacare state of Maryland has announced double-digit premium increases for state residents who will purchase insurance through the Obamacare exchange starting next year. They're touting the fact that the coming hikes aren't quite as high as they might have been -- but "less severe premium increases than what might have been" wasn't the promise, was it? (2) A little-known Obamacare tax is "catching businesses off-guard" across the country, and adding to the cost of providing coverage. (3) We've covered the businesses who are downsizing or converting full-time workers to part-time employees to escape the now-delayed Obamacare employer mandate. Guess who won't receive care through their employer? Many of the workers manning the phones at Obamacare call centers:
Earlier this year, Contra Costa County won the right to run a health care call center, where workers will answer questions to help implement the president's Affordable Care Act. Area politicians called the 200-plus jobs it would bring to the region an economic coup. Now, with two months to go before the Concord operation opens to serve the public, information has surfaced that about half the jobs are part-time, with no health benefits -- a stinging disappointment to workers and local politicians who believed the positions would be full-time. The Contra Costa County supervisor whose district includes the call center called the whole hiring process -- which attracted about 7,000 applicants -- a "comedy of errors."
Yes, a dark comedy, and no one is laughing. In another rich irony, the union representing IRS employees -- who will oversee Obamacare enforcement -- has come out hard against a proposal to make its members reliant on the new law for coverage. The IRS doesn't want any part of the law they'll be enforcing on millions of Americans. I'll leave you with this story. Headline: "Detroit looks to health law to ease costs." Good luck with that.