Example, please!

Mickey Kaus Columnist
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How Not to Win the “Death Panel” Debate: Arguments in favor of Obamacare’s appointed, cost-cutting “Independent Payment Advisory Board”–like this effort from the Center on Budget and Policy Priorities–would be a lot more persuasive if they gave at least one (1) concrete example of ineffective health spending the IPAB will eliminate to achieve its cost target. We’re assured the “board may not make recommendations to ration health care, cut benefits, increase premiums and cost sharing, or restrict eligibility” for Medicare. Good to hear! (And we know they would never try to finesse the definition of “ration.”) So what would they recommend? …

P.S.: The CBPP paper does suggest that

IPAB could propose higher payments for treatments and prevention activities that are found to be more cost-effective.

a) Such as … b) You really think higher payments will wind up saving money? What happens when if they don’t? ….

P.P.S.: If I were trying to repeal IPAB, I’d xerox the CBPP brief and send it to everyone in Congress. Much of it is devoted to the argument that IPAB won’t really cut much because it probably “will not be needed” to achieve Obamacare’s cost-cutting goals. But if it isn’t needed …

Backfill: Here’s a Jon Cohn IPAB defense. No example there either–though there’s a relatively concrete account of how IPAB might prove its critics right:

The less extreme, more honest criticism of IPAB is that it will encourage payment schemes that lead to indirect rationing, by restricting access to the people who provide care. According to this argument, doctors are already turning away patients because of low reimbursements. Once IPAB ratchets down payments further, they’ll turn away even more patients.

Here’s Ezra Klein. No example. Even Henry Aaron, the grown-up’s Ezra Klein–no examples I can find. (Aaron does argue that “through 2020, savings would have to be found in private Medicare Advantage plans, Medicare’s Part D prescription-drug program, or spending on skilled-nursing facilities, home-based health care, dialysis, durable medical equipment, ambulance services, and services of ambulatory surgical centers.” OK. Name a saving in those areas that would not adversely affect care. I’m ready to be convinced!)

P.P.S.: It’s frequently said that, once IPAB comes up with its cost-saving ideas “Congress must adopt these recommendations — or come up with its own savings.” This statement appears to be wrong, as the CBPP more or less admits. It’s hard to see how any legislation, even Obamacare, can bind future Congresses. If in 2018 the elected Congress wants to repeal the whole law, it can. If it wants to negate any or all recommendations of the IPAB, it can–by the ordinary legislative process that requires passage by House and Senate and signature by the President (or override of a veto). The CBPP says:

The board’s recommendations will go into effect automatically unless Congress passes, and the President signs, legislation to modify or overturn them. [E.A.]

Congress needs to “come up with its own savings” only if it wants to pass them on the “fast track” provided by the law. But of course, future Congresses could change the fast track.

At least I think this is right. I don’t see how it could be any other way. …

Mickey Kaus