‘More Cowbell’ on Medicare

Mickey Kaus Columnist
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Igor Volsky: If you like IPAB (Obamacare’s Independent Payment Advisory Board), you’ll love Obama’s proposed Medicare cuts! Problem: We hate IPAB. …

Why? IPAB’s an intentionally anti-democratic board of “experts” tasked with cutting a fixed amount of costs from Medicare (an amount Obama’s latest deficit plan would increase). We are of course assured that the IPAB board would only cut useless treatments–the famous “red pill” vs. the “blue pill”– but under cost pressure it’s pretty clear they’ll quickly move on to denying or penalizing what they consider cost-ineffective treatments–including treatments that are expensive but only seem to help a little bit or help only some of the time (even though new research on effectiveness often proves authoritative earlier conclusions wrong). After that, it’s on to cutting treatments that help people who are only going to die soon anyway. …

Why is this progression obvious? Because Obama telegraphed it himself, at the beginning of his term, by illustrating IPAB’s purpose with an anecdote about his grandmother, who received a hip operation after being told “maybe you have three months, maybe you have six months, maybe you have nine months to live.” Hip replacements aren’t useless. They work. They aren’t cost-ineffective. The only reason to deny one to Obama’s grandma is that she was near the end of her life (though denying her the operation could have meant she lived her remaining months in pain).

P.S.: In that early interview, Obama also said IPAB’s judgment on effectiveness would be  “not determinative.” It would just “give you some guidance.” It sure seems determinative now. From NRO:

Under the law, there are only a few ways for the board’s cost-control recommendations to be amended. Congress can pass alternative measures that reduce Medicare spending by at least as much as the IPAB proposal; or, three-fifths of the Senate can vote to override the IPAB proposal entirely. If Congress fails to pass its own version by a certain deadline and the Senate doesn’t waive the requirement with a three-fifths vote, the board’s recommendations automatically become law.

Details here.

P.P.S.–More Cowbell: Does Obama really want to renew his stress on IPAB? The board may or may not evolve into a Brit-style “death panel,” but it’s pretty clear the President’s emphasis on treatment-cutting is a big reason his health care plan was unpopular when it passed and remains unpopular today. Bringing it all up again doesn’t only risk sealing the fate of the IPAB board. It might sink all of Obamacare after 2012. Hardly seems worth it to score a few debating points off the GOPs. … Remember your point about the need to be less wonky, Mr. President?  And remember who championed IPAB? The same man who may have slimed you to Ron Suskind ….

Backfill: Andrew Stiles of NRO heard the cowbell hours ago. …

Mickey Kaus