Are you in favor of allowing a committee of unaccountable and unelected bureaucrats to dictate the personal health care decisions of millions of American seniors?
In an Orwellian twist, the most powerful committee created by the recent health care law is called the “Independent Payment Advisory Board” (IPAB). The board is independent all right — independent of accountability. But it is certainly not “advisory.” All decisions are final and they carry the force of law, unless Congress is able to mount an override.
Last week, Congress held several hearings about IPAB and its controversial authorities. IPAB will be responsible for cutting payment rates for doctors and for determining which Medicare treatments are too wasteful or expensive. Because of its broad authority and its lack of accountability to voters, IPAB has begun to receive a great deal of public and political scrutiny.
IPAB will consist of 15 unelected bureaucrats, all appointed by the president. These appointments do not require Senate confirmation. Once the commission forms, it will begin making recommendations to “reduce the per capita rate of growth in Medicare spending.” According to the new health care law, these recommendations from IPAB will automatically become law, unless Congress overrides the recommendation with a three-fifths majority in both the House and the Senate.
The commission will have a profound impact on the U.S. health care system, and seniors in particular. Surveys of doctors reveal that many physicians already limit the number of Medicare patients they will see because of the low reimbursement rates. IPAB’s future cuts may make it difficult for seniors with Medicare to find a doctor.
One of the primary reasons for IPAB opposition is its lack of accountability and transparency. The board’s unelected officials will be given broad discretion to make cuts for physician reimbursements and use “comparative-effectiveness research” to determine which drugs should be funded. As is true of all unelected bureaucrats, the IPAB commissioners will never have to give an accounting of their decisions to the voters.
As the federal government has expanded and amassed new powers, a growing number of state officials and voters have sought solutions at the state level. In the area of health care policy, more states are searching for solutions that meet their own unique needs, rather than relying on one-size-fits-all programs designed in Washington, D.C. Last year, a grassroots coalition formed to shift health care decision-making authority from Washington, D.C. to the states. The coalition, known as the Health Care Compact Alliance, supports an interstate compact as a device that allows states to regain control of health care decisions.
The Health Care Compact would empower states to create their own Medicare and Medicaid programs, free from the arbitrary decisions of unelected bureaucrats in Washington, D.C., including those on the powerful IPAB commission. States participating in the Health Care Compact will be given the authority to design their own health care programs, but will continue to receive their portion of federal health care dollars.
The Health Care Compact is already law in Georgia, Oklahoma, Missouri and Texas, and has been introduced in state legislatures in Ohio, Michigan, Tennessee, Colorado, South Carolina and Louisiana. Once Congress approves the compact, it will carry the full force of federal law and will trump the federal Health and Human Services regulations, as well as the recommendations of IPAB. States that choose to participate in the Health Care Compact will be given autonomy over health care policy.
Empowering unaccountable and unelected officials with expansive authority to legislate — as IPAB does — moves us away from self-governance. The Health Care Compact, on the other hand, will yield greater transparency and accountability by returning decision-making authority to elected officials in the states, and to the people they represent.
Eric O’Keefe is the chairman of the Health Care Compact Alliance and CEO of the Sam Adams Alliance.