Big brouhaha over obscure Medicare board

By RICARDO ALONSO-ZALDIVAR , Associated Press
In this July 13, 2011 file photo, Republican presidential candidate, Rep. Michele Bachmann, R-Minn. takes part in a news conference on Capitol Hill in Washington. So long death panels. Hello "rationing" board. An independent panel authorized by President Barack Obama's health care law to control excessive Medicare cost increases is drawing heavy fire from Republicans. Nearly every health industry lobbying group is pushing for its repeal, as are some consumer advocates. GOP lawmakers call it a rationing panel, and at least one has suggested seniors will die from its decisions. (AP Photo/Susan Walsh, File)

(AP) -- Remember the debunked death panels? A new Medicare board that Republicans are calling a "rationing panel" could become the next boogeyman in the nation's hyperbolic health care debate.

But don't look for the Independent Payment Advisory Board to start slashing anytime soon. IPAB doesn't even exist yet. Although the new health care law authorized the board to control excessive Medicare cost increases, President Barack Obama can wait until after the 2012 election to set it up.

IPAB is forbidden by law from rationing, but that hasn't stopped critics. Nearly every health industry lobbying group is pushing to repeal it, as are some consumer advocates.

IPAB has the power to force Medicare cuts if costs rise beyond certain levels and Congress fails to act. Medicare's own experts predict IPAB cuts will be needed in 2018 and 2019. If that happens, the law explicitly prohibits IPAB from rationing care, shifting costs to retirees, restricting benefits or raising the Medicare eligibility age.

Yet the uproar is getting louder.

"Senior citizens will lose control over what they actually get in Medicare," GOP presidential candidate Michele Bachmann told conservative bloggers in Minneapolis last month, "because a politically appointed 15-member board that's unelected and unresponsive to the will of the people called IPAB will make the decisions about what care we get and what care we don't."

After their own plan to essentially privatize Medicare for future retirees ran into trouble, Republicans became more vocal about IPAB. At a news conference of the GOP Doctors Caucus, Georgia Rep. Phil Gingrey suggested the board could leave a trail of bodies.

"Under this IPAB ... a bunch of bureaucrats decide whether or not you get care, such as continuing on dialysis or cancer chemotherapy," said Gingrey, an ob-gyn physician. "I'll guarantee you, when you withdraw that, the patient is going to die."

IPAB does represent an unusual delegation of power by Congress to what would be a new executive branch agency. But the administration doesn't seem to be rushing to take advantage.

Just this spring, Obama had proposed beefing up IPAB to squeeze Medicare harder. But as opposition grew, and prominent House liberals and AARP voiced their own objections, the administration played down that idea. In recent testimony before two House committees, Health and Human Services Secretary Kathleen Sebelius said IPAB is just a "backstop," a "failsafe."

"If Congress is actually paying attention to the bottom line of Medicare, IPAB is irrelevant ... and it never triggers in," she said.

Obama hasn't made any moves to set up the new agency, said Sebelius, but has only consulted about possible board candidates. Those members would have to be confirmed by the Senate, a fight the administration may be unwilling to pick when it can't even get Medicare chief Don Berwick approved.

"The more interesting question is whether it will ever get off the runway," said economist Robert Reischauer, one of the public trustees overseeing Medicare finances. "Can they find 15 people willing to serve under the conditions laid out in the legislation? Will the Senate confirm them?"

It wouldn't be the first time cries of rationing forced Democrats to pull back. During the congressional health care debate, Sarah Palin denounced a plan to have Medicare pay for voluntary end-of-life consultations between patients and their doctors. Although the "death panels" accusation was discredited, the idea got dropped.

Rationing is a criticism Americans respond to, said Reischauer. "They are fearful that health reform might include limitations on their ability to access any care they consider worthwhile."

HHS spokeswoman Erin Shields said comments such as Gingrey's amount to "scare tactics" and IPAB is "absolutely prohibited" from rationing. It could recommend savings that don't involve cuts, she said.

Backers say the board is meant to balance a Congress addicted to spending, unable to turn down lobbyists for hospitals, doctors, drug companies, nursing homes, power wheelchair companies and other businesses that depend on Medicare, and whose executives and employees make political contributions.

"The system now is that people come up here that work the Congress like crazy, lobbyists making millions of dollars," said Sen. Jay Rockefeller, D-W.Va., one of IPAB's biggest supporters. "The Congress often doesn't know how to say no. And the Congress has the practice of never saying no. And costs go up."

Dispassionate experts can do a better job, Rockefeller contends. Some of his colleagues don't like IPAB "because they don't get ... the big connection with the lobbyist," he added. Under the law, Congress can override the board's recommendations with its own savings, as long they add up to the same total.

Critics say their concerns can't be dismissed as easily as that. Because IPAB is an attempt to cap Medicare spending, a stingy approach could stifle promising new medical innovations. And if IPAB leads to steep payment cuts, doctors and other providers will be reluctant to take Medicare patients, limiting access even without explicit rationing.

"It will in effect be used to ration care or limit access," said Sen. John Cornyn, R-Texas, leading the push for repeal.

The early evidence does not seem particularly alarming.

For example, the nonpartisan Congressional Research Service tried last fall to estimate the impact of projected IPAB cuts and came up with about $60 per year, per beneficiary from 2015-2019. Annual Medicare spending during that period was estimated to increase from an average of $13,374 per enrollee in 2015 to $15,749 in 2019.

Updated cost projections from other government offices differ on whether IPAB cuts will be required in the short run. The Congressional Budget Office says no. But Medicare's Office of the Actuary says yes, in 2018 and 2019. Under the law, it's the actuary who makes the call.

That's keeping critics on edge.

4.5 /5 (2 votes)
add to favorites email to friend print save as pdf

Related Stories

Seniors may have to pay for Medicare home health

Jan 13, 2011

(AP) -- Medicare recipients could see a new out-of-pocket charge for home health visits if Congress follows through on a recommendation issued Thursday by its own advisory panel.

Uncertainty over Medicare pay sets doctors on edge

May 27, 2010

(AP) -- For the third time this year, Congress is scrambling to stave off a hefty pay cut to doctors treating Medicare patients - even as the Obama administration mails out a glossy brochure to reassure seniors ...

Obama administration eases pain of Medicare cuts

Apr 20, 2011

(AP) -- Millions of seniors in popular private insurance plans offered through Medicare will be getting a reprieve from some of the most controversial cuts in President Barack Obama's health care law.

Doctors brace for possible big Medicare pay cuts

Nov 13, 2010

(AP) -- Breast cancer surgeon Kathryn Wagner has posted a warning in her waiting room about a different sort of risk to patients' health: She'll stop taking new Medicare cases if Congress allows looming cuts ...

Recommended for you

Report highlights progress, challenges in health IT

14 hours ago

(HealthDay)—Progress has been made toward widespread adoption of electronic health records (EHRs), although there are still barriers to adoption of advanced use of EHRs, according to a report published ...

Training your brain to prefer healthy foods

14 hours ago

It may be possible to train the brain to prefer healthy low-calorie foods over unhealthy higher-calorie foods, according to new research by scientists at the Jean Mayer USDA Human Nutrition Research Center ...

Outdoor enthusiasts need a lightning plan

14 hours ago

(HealthDay)—Those partaking in outdoor sports and activities need to be aware of the threat posed by lightning and take appropriate safety measures, experts say.

User comments

Adjust slider to filter visible comments by rank

Display comments: newest first

dogbert
1 / 5 (1) Jul 18, 2011
If a bill to kill that panel were to be presented, it would likely pass. Democrats and Republicans would vote to end it.
frajo
5 / 5 (4) Jul 19, 2011
I don't understand this noise. Maybe because I'm European.

Isn't every insurance that denies some expensive cancer treatment a "death panel"?
Isn't a society that denies millions of its inhabitants medical insurance just another form of a "death panel"?
FrankHerbert
1 / 5 (5) Jul 19, 2011
Isn't a society that denies millions of its inhabitants medical insurance just another form of a "death panel"?


No, this is called "freedom". I kid.
dogbert
1 / 5 (1) Jul 19, 2011
frajo,

It is not so much about deciding that a certain medical practice is too expensive or over used. For example, MRI's are expensive and extremely overused. Efforts to moderate their usage make perfect sense and are not resisted.

It is about deciding that you, because you are a certain age, have certain co-morbid conditions, etc. do not deserve a certain procedure which is available for everyone else.

John Nuttall is an example in the UK of what people are objecting to. He was denied surgery on a broken ankle because he smoked.

http://www.outsid...n_ankle/
Shootist
1 / 5 (2) Jul 23, 2011
Isn't a society that denies millions of its inhabitants medical insurance just another form of a "death panel"?


What society denies millions of its inhabitants medical insurance?

Medical insurance, like food and clothing, is a commodity. It is bought on the open market from vendors who specialize in the sale and maintenance of such items. If you are responsible, in good health and have a few shekels, you can buy medical insurance.

If you are indigent, you may receive care at any hospital emergency room.

It isn't a perfect system but it is a better system than one that would treat everyone, 'equally', regardless of ability to pay. Such a system would require stealing other people's money to pay for it. And of the two, that is the greater tyranny.
Vendicar_Decarian
2.3 / 5 (3) Jul 23, 2011
Yes. American Republicans and Libertarians call that "Freedom".

Freedom to be denied health care service.

"Isn't every insurance that denies some expensive cancer treatment a "death panel"?" - Frajo
Vendicar_Decarian
2.3 / 5 (3) Jul 23, 2011
As usual Dogbert isn't telling the whole story.

There is valid medical reasoning behind the decision.

"John Nuttall is an example in the UK of what people are objecting to. He was denied surgery on a broken ankle because he smoked." - Dogbert

Doctors at the Royal Cornwall Hospital in Truro have refused to operate because they say his heavy smoking would reduce the chance of healing, and there is a risk of complications which could lead to amputation.

The reason his ankle didn't heal properly in the first place after being immobilized by a cast is that he is a heavy smoker.

If he was smart, he would quit and then he would get the operation.

Quitting smoking is part of his payment for the procedure.

Vendicar_Decarian
2.3 / 5 (3) Jul 23, 2011
"It isn't a perfect system but it is a better system than one that would treat everyone, 'equally', regardless of ability to pay." - ShooTardist

The U.S. system costs twice that of European systems and produces vastly inferior results - unless you are wealthy.

Only Republican/Libertarian Traitors would promote and protect an inferior system that is double the cost.

ryggesogn2
2.3 / 5 (3) Jul 24, 2011
"IPAB is forbidden by law from rationing, "
The US govt has laws it is supposed to enforce to keep out illegal aliens. It selectively and sparingly applies the law.
Why would any US govt agency feel constrained by such a silly thing as a law?
dogbert
3 / 5 (2) Jul 24, 2011
Vendicar_Decarian,
As usual Dogbert isn't telling the whole story.

No, as usual, you make untrue comments like that. What I said was true and I posted a link to a news article with more information.
Doctors at the Royal Cornwall Hospital in Truro have refused to operate because they say his heavy smoking would reduce the chance of healing, and there is a risk of complications which could lead to amputation.

It should be noted that not surgically repairing an ankle fracture which is not healing increases the chance of not healing to 100% and that there is a large chance of complications leading to amputation.
The reason his ankle didn't heal properly in the first place after being immobilized by a cast is that he is a heavy smoker.

Why do you pretend to knowledge you do not have? There are many reasons a fractured bone may not heal properly. You do not know the reasons John's ankle did not heal.

continued...

dogbert
3 / 5 (2) Jul 24, 2011
Vendicar_Decarian continued,

Quitting smoking is part of his payment for the procedure.


Really? In a system which provides "free" medical care, John Nuttall must make payment?

No. The physicians do not like John because he smokes and would rather he remain crippled and possibly die from his injury than repair the break.

Such arrogant inhumanity would not prevail in the United States. He would have received the surgical care he needed.
Vendicar_Decarian
2.3 / 5 (3) Jul 24, 2011
"In a system which provides "free" medical care, John Nuttall must make payment?" - Dogbert

Ya, he has to cooperate with the doctors in his own medical care.

And he has to breathe too. The horror... The horror.

You poor boy you.
Vendicar_Decarian
2.3 / 5 (3) Jul 24, 2011
"Such arrogant inhumanity would not prevail in the United States." - Dogbert

In the U.S. the doctors would just demand payment and toss you out on the street if you couldn't pay the tribute they demand.

You know, like when American hospitals drive patients hundreds of miles away and dump them in the middle of some remote town just so that they can lower their costs.

Vendicar_Decarian
2 / 5 (4) Jul 24, 2011
"The US govt has laws it is supposed to enforce to keep out illegal aliens." - RyggTard

From the Libertarian/Randite party platform....

We hold that human rights should not be denied or abridged on the basis of nationality. We condemn massive roundups of Hispanic Americans and others by the federal government in its hunt for individuals not possessing required government documents.

We strongly oppose all measures that punish employers who hire undocumented workers. Such measures repress free enterprise, harass workers, and systematically discourage employers from hiring Hispanics.

We welcome all refugees to our country and condemn the efforts of U.S. officials to create a new "Berlin Wall" which would keep them captive.

cont...
Vendicar_Decarian
3 / 5 (4) Jul 24, 2011
We condemn the U.S. government's policy of barring those refugees from our country and preventing Americans from assisting their passage to help them escape tyranny or improve their economic prospects.

Undocumented non-citizens should not be denied the fundamental freedom to labor and to move about unmolested. Furthermore, immigration must not be restricted for reasons of race, religion, political creed, age, or sexual preference.

We therefore call for the elimination of all restrictions on immigration, the abolition of the Immigration and Naturalization Service and the Border Patrol, and a declaration of full amnesty for all people who have entered the country illegally. We oppose government welfare and resettlement payments to non-citizens just as we oppose government welfare payments to all other persons.
Vendicar_Decarian
3 / 5 (4) Jul 24, 2011
After reading the above Libertarian Platform I have to wonder if there is there no end to the Libertarian/Randite treason against America?
dogbert
1 / 5 (1) Jul 24, 2011
Vendicar Decarian,
Quitting smoking is part of his payment for the procedure.


In the U.S. the doctors would just demand payment and toss you out on the street if you couldn't pay the tribute they demand.


No, that is what the doctors did in the U.K. You should actually read the stuff you write.

Vendicar_Decarian
2.3 / 5 (3) Jul 24, 2011
"No, that is what the doctors did in the U.K." - DogberTard

Poor dogberTard can't read.

His own reference states that treatment was withheld because he patient's own behaviour - would most probably prevent the success of the treatment denied. Hence on the grounds of efficacy it was denied.

The problem with Tards like DogberTard is that they don't live in the reality based community. They live in a ConservaTard fantasy land manufactured from distortions and lies.

Thanks for the example of your idiocy DogberTard.
dogbert
1 / 5 (1) Jul 24, 2011
Both those statements above were YOUR statements, Vendicar, not mine.

You said that his payment for the procedure was that he quit smoking. Then you said that US doctors would have demanded payment or tossed him out on the street.

Your own words were that the UK doctors demanded payment and tossed him out on the street when he did not pay.

I only noted that in the US, he would not have been treated inhumanely. He would have received the needed surgery.

You should really read what you say.
Vendicar_Decarian
2.3 / 5 (3) Jul 24, 2011
"Both those statements above were YOUR statements, Vendicar, not mine. " - DogberTard

They are from your own reference.. You pathetic Fool.

"I only noted that in the US, he would not have been treated inhumanely. He would have received the needed surgery." - DogBerTard

He has not been treated inhumanely. His extreme smoking reduces the efficacy of the treatment to the point where it his doctors feel it is a waste of resources to proceed.

All he need do to receive treatment is stop acting in a manner that will make that treatment a failure.

Your example is a fine example of the waste of medical resources in the U.S. system.

This waste is one of the reasons why the U.S. system is such a spectacular failure.

dogbert
1 / 5 (1) Jul 24, 2011
vendicar,
They are from your own reference.. You pathetic Fool.

No, they are direct quotes from you. Let me quote you again:
Quitting smoking is part of his payment for the procedure.

In the U.S. the doctors would just demand payment and toss you out on the street if you couldn't pay the tribute they demand.


Both of those statements were copied directly from your posts.

In the "free" system in the U.K., he has no recourse. He can be denied necessary care and he has no where else to go. In the U.S., he would obtain the surgery he needs. He would also receive smoking cessation assistance if he wished to quit.

The "free" system is inhumane. Forcing a person to remain crippled with a broken ankle when a simple surgical procedure could repair the bone is patently inhumane.

The U.S. does not want a system which encourages such practices.
FrankHerbert
1.7 / 5 (6) Jul 24, 2011
"Inhumane", lmao. Your fake outrage is despicable, dogbert. You know DAMN WELL lack of health insurance causes far greater inhumanities.

So which is worse:

1) Present someone with the option to get his shit in order to to become healthy enough to not make the procedure a waste

-or-

2) Ruin someone financially for something out of one's control.
dogbert
1 / 5 (1) Jul 24, 2011
Frankie,

Surgical repair of his ankle would not have ruined him financially. Besides, if he had no resources, he could have obtained services through Medicaid and payed nothing.

It is the U.K., which denies him necessary care and provides him with no recourse, which is inhumane.

When you deny care based on your dislike of someone's behaviors instead of treating his/her medical needs, you show yourself to be bigoted. Care should be provided based on need. Mr. Nuttall obviously needed surgery but it was denied because his doctors did not want to provide care to someone who smoked.

It was discriminatory and would not have been allowed in the U.S.
FrankHerbert
1 / 5 (5) Jul 24, 2011
You can't simultaneously say "well he could just get Medicaid" while you rail against all social programs. Everything you have ever said on here suggests you would dismantle Medicaid in a heartbeat.
dogbert
1 / 5 (1) Jul 25, 2011
Of course I can point out the availability of Medicaid to someone who is indigent.

Everything you have ever said on here suggests you would dismantle Medicaid in a heartbeat.


You have never heard me say anything of the sort.

You fail to address the issues.

* Don't you agree that it is discriminatory to deny service because the physicians don't like the client's behavior?

* Don't you agree that a system which leaves a person with no ability to obtain needed medical services is flawed?
FrankHerbert
1 / 5 (5) Jul 25, 2011
"Though the public system dominates healthcare provision in England, private health care and a wide variety of alternative and complementary treatments are available for those willing to pay." (Wikipedia)

It's a moot point dogbert. He CAN pay to see a private doctor if he wants, just like he could in the US.

But to actually answer your questions (something you seem to avoid like hell):

* Don't you agree that it is discriminatory to deny service because the physicians don't like the client's behavior?


No, I don't. A doctor shouldn't be forced to do a procedure he doesn't want to. If he thinks the person isn't healthy enough, or it interferes with the doctor's morality, whatever. Do you think doctors should be forced to give abortions?

* Don't you agree that a system which leaves a person with no ability to obtain needed medical services is flawed?


Yes I do, but for all intents and purposes YOU don't. This is the effective situation for many Americans.
dogbert
not rated yet Jul 25, 2011
* Don't you agree that a system which leaves a person with no ability to obtain needed medical services is flawed?

Yes I do, but for all intents and purposes YOU don't. This is the effective situation for many Americans.


I do think it is wrong. That is why I posed the question. That situation is the situation in the U.K. John Nuttall was denied needed surgery because the physicians did not like the fact that he smoked. In the U.K., he has no recourse unless he is wealthy, which he obviously is not.

In America, the indigent are cared for. They are not left with no recourse.