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The Health Care Bureaucrats Elimination Act

Dr. Coburn is an original cosponsor of the Health Care Bureaucrats Elimination Act, S. .3653. This bill would repeal Section 3403 of the new health care law that created the Independent Payment Advisory Board.

Proponents of the new health law cite the IPAB as an important mechanism to lower cost the federal government over time. However, the very health law that created the IPAB increases federal spending on health care, according to the Chief Actuary of the Centers for Medicare and Medicaid Services. Furthermore, the IPAB is only projected to reduce costs because unelected, unaccountable bureaucrats in Washington, DC would effectively make health care coverage decisions based on costs – not based on the best care decisions for individual patients.

The Independent Payment Advisory Board (IPAB) is a troubling, yet stark example of the deep philosophical divide over the way to improve American health care. I strongly believe that individual health care decisions should remain between patients and their physicians. Elite, unelected, unaccountable technocrats in Washington, DC are not smarter or wiser than the American people. Americans should be trusted with their health care dollars and will make better decisions than bureaucrats, when they have good information and properly aligned incentives.

Purpose: The Health Care Bureaucrats Elimination Act would remove unelected, unaccountable bureaucrats from seniors’ personal health decisions by repealing the Independent Payment Advisory Board (IPAB).

IPAB Summary: After pillaging $528 billion from the nearly bankrupt Medicare program to create a $2.6 trillion new entitlement, the Obama-Reid-Pelosi Patient Protection and Affordable Care Act (PPACA) created an unelected, unaccountable board of bureaucrats to make additional cuts to the Medicare program based on arbitrary global budget targets. The IPAB would empower 15 bureaucrats to make substantial changes to Medicare—without full transparency and accountability to America’s seniors and their elected officials.

Additional Background:

Radical Change: In an editorial last fall, the Wall Street Journal dubbed an early version of IPAB “The Rationing Commission” and stated, “If Democrats impose such a commission nationwide, it would constitute a radical change in U.S. health care. The reason that physician discretion—not Washington's cost-minded judgments—is at the core of medicine is that usually there are no ‘right’ answers. The data from large clinical trials produce generic conclusions that rarely apply to individual patients, who have vastly different biologies, response rates to treatments, and often multiple conditions.”

Product of Politics: While the designers of IPAB contend it will “depoliticize” the Medicare payment process, the IPAB’s very charter is the product of politics. Special interest groups cut deals with Democrats to specifically exempt hospitals, 28% of Medicare's budget, from the IPAB’s ax. Additionally, IPAB simply takes decision-making authority from democratically elected officials and gives it to the President’s political appointees. By way of contrast, the WSJ noted last fall that “The only way to take the politics out of health care is to give individuals more power to control medical dollars.”

Shirked Responsibility: While IPAB was sold as a mechanism to address entitlement spending, the reality is that IPAB allowed Congress to punt to an unaccountable board the responsibility of fully paying for a budget busting new entitlement program. The history of the more than $300 billion Sustainable Growth Rate problem has shown that punting budget problems down the road only makes them worse for patients, providers, and taxpayers.

Fallible Bureaucrats: IPAB’s body of “experts” was modeled in many ways after the Medicare Payment Advisory Commission (MedPAC). However, MedPAC doesn’t always get it right, and its recommendations are carefully examined by Congress before legislative action. As the Wall Street Journal reported last year, “The Medicare Payment Advisory Commission, created by Congress in 1997, has recommended more than $200 billion in cost cuts in the last year alone that lawmakers have ignored.”

Jeopardized Access: IPAB has raised significant concerns among a diverse group of health care provider groups. 75 provider groups sent a letter stating their opposition to IPAB stating, “The IPAB reductions would be in addition to the…savings in provider payments already included in health care reform legislation, which could jeopardize both access for Medicare beneficiaries and even infrastructure for the entire health care system.”