Right now only one man can butcher Medicare, and that man is Barack H. Obama. Not one to be daunted by the seemingly unthinkable, like bombing yet another country, Obama has begun to hone his blade of choice for Medicare cuts.
His instrument is the “Independent” Payment Advisory or IPAB, part of the already enacted ObamaCare. Recently Obama proposed that this board, appointed by the President, take on a new role, that of “deficit reduction.” Despite the importance of this development, the Times carried only one brief article on it, describing the IPAB with its new duties as “a powerful independent board that could make sweeping cuts in the growth of Medicare spending.”1
Let us put this in context right away. First, the U.S. is by far the richest country in the world with one quarter of the world’s GDP and a per capita GDP 17% higher than Canada’s and 40% higher than France’s, both of which provide universal health care of high quality, with France rated as the best health care system in the world by the WHO. There is no reason for cruel cuts in Medicare, other than the extraordinary power of that rapacious wing of parasitic finance capital called the insurance industry. Instead we should be expanding Medicare to cover everyone.
Second the cognoscenti on health care may be saying to themselves at this point, “Wait, that is just what countries like Canada do; they establish a global budget to put a lid on costs.” And that is a good point at first blush. For an answer we turn to the indispensible daily brief by Dr. Don McCanne of Physicians for A National Health Program.2 Here is what Dr. McCanne says. IPAB raises “an important point that we have made before and must make again: Applying a cap on Medicare payments alone at GDP plus one-half or one percent (as IPAB will do, jw), without placing the same caps on the rest of health care spending, risks devolving Medicare into an underfunded, lower tier welfare program, with impaired access for Medicare beneficiaries because of a lack of willing providers.”
The same point is made by the Kaiser Family Foundation, thus: “If IPAB recommends policies that squeeze Medicare payment rates without equal pressure being placed on private payment rates, there is some concern that Medicare beneficiaries would be at greater risk of having access problems, as providers become more inclined to serve other patients.”3
These dangers are made more acute by the political realities. First, if Republicans set out to kill Medicare, as for example in the voucher scheme of Rep. Paul Ryan, then the Democrats are sure to raise objections to scare up some votes. But if Obama does the same in a less forthright way, there will be silence from the Dems and from the majority of the grass roots health activists who are securely anchored to the illusion of “the lesser evil.” Second, the IPAB puts Medicare cuts beyond the control of elected representatives, the very thing that has prevented the demolition of Medicare over the years. Get a reputation for opposing Medicare and get ousted in the next election. That has been the simple rule. Here Obama is being very clever by putting Medicare cuts beyond the reach of Congress. It is true that Congress could overrule the IPAB, but it needs to do so with a veto-proof supermajority, which is difficult indeed. So as with war, Congress can simply give up more authority and thereby dodge blame but place Medicare in mortal peril.
For this very reason, however, the Republicans may prove the best friends of Medicare, along with a few hardy Democrats. From the Tea Party to some progressive Dems there is resistance to further erosion of Congressional power. Rep. Pete Stark, senior Democrat on the Ways and Means Subcommittee on Health, commented tersely on the IPAB, one of only four Democrats to raise objections to it so far: “Why have legislators?” He went on to say that the IPAB may be worse than Ryan’s vouchers: “In theory at least, you could set the vouchers at an adequate level. But in its effort to limit the growth of Medicare spending, the board is likely to set inadequate payment rates for health care providers, which could endanger patient care.” This of course is the same point raised above by Dr. McCanne and the Kaiser Family Foundation study.
But the Republicans are even more determined to put the IPAB in a bad light – not out of altruism but to get votes. Although the right thing for the wrong reason, it is still the right thing. Thus Republican Senator John Cornyn, complained that the IPAB “punts difficult decisions on health spending to an unelected, unaccountable board of bureaucrats.” And Republican Rep. Paul Ryan, he of Medicare voucher fame, calls the IPAB “a rationing board” and agrees with Cornyn and Stark that Congress should not “delegate Medicare decision-making to 15 people appointed by the president.” Ryan then said that IPAB would allow Obama to “impose more price controls and more limitations on providers, which will end up cutting services to seniors.” He is right.
So the Democrats claim that the Republicans want to destroy Medicare and the Republicans say the same of Democrats. The bitter truth is that they are both right. Progressives, Libertarians and genuine Conservatives all have good reason to oppose Obama’s nefarious IPAB.
- Obama Panel to Curb Medicare Finds Foes in Both Parties. [↩]
- Scroll down to “Comments” at the end. [↩]
- The Independent Payment Advisory Board. [↩]