Maybe the heat and the debt negotiations are getting to me, but I felt my blood pressure rise this week when I saw the reports on the new efforts to repeal the Independent Payment Advisory Board (IPAB). Following the back-to-back House hearings on IPAB, media reports, blogs and transcripts from various Hill events were calling attention to claims by some members of Congress and pundits that IPAB was really an acronym for death panel. Seriously – that, again?
IPAB, passed as part of health care reform in the Accountable Care Act, is, or will eventually be, the new government agency tasked with reducing the rate of growth in Medicare without affecting coverage or quality.
For the record, NHPCO does not support IPAB, and we engaged in efforts to remove the Board from the final health care bill. I’m not going to debate the merits of IPAB’s existence here. But, let’s be clear about one thing: IPAB is not a rationing panel and it is certainly not a death panel. In fact, the ACA specifically prohibits IPAB from rationing care. So why are physicians in Congress saying that IPAB will cause seniors to die?
Maybe there is some real strategy behind this tactic. The last time that particular phrasing was thrown about alongside the term ‘rationing,’ the Administration abandoned something we did support: Medicare reimbursement for voluntary advance care planning consultations. We’ve been here before and the hospice community knows all too well the costs of such scare tactics. The previous iteration of this particular brand of fighting left Medicare beneficiaries afraid to talk to their doctors about their end-of-life wishes for fear that some panel of government bureaucrats would ultimately decide whether they lived or died.
Although the Board is not supposed to produce recommendations until 2014, there are already many working against its very creation, not to mention its effectiveness. Not only does the Administration seem to be in no hurry to set up IPAB and take on another high profile health care battle, but who would want to serve on it and go through the Senate confirmation process? At the same time, pretty much every health care provider group and quite a few consumer groups are lining up and lobbying for its repeal. And with a few Democrats who votes for health reform starting to call for its repeal, maybe it is safe to say that IPAB is currently on uncertain ground.
But, if there is ground to be gained in weakening or even eliminating IPAB, let’s debate that on the policy merits. Whatever our views on IPAB, we have to resist the urge to engage in such dangerous rhetoric. At this rate, we have no idea what portion of health reform will be the next political bogeyman – – but, let’s hope this is the last we’ll hear of death panels.