In a Wall Street Journal op-ed Sunday, former Vermont governor Howard Dean (D) pointed to what he believes is the “one major problem” plaguing the Affordable Care Act: the Independent Payment Advisory Board (IPAB).
Dean, who begins his op-ed by referencing the future benefits of Obamacare, describes the controversial 15-member IPAB as “essentially a health care rationing body,” one that has the ability to establish doctor reimbursement rates for Medicare and determine “which procedures and drugs will be covered and at what price.”
The IPAB’s sole mandate is simply to drive down Medicare spending; in order to do so, it can dictate Medicare spending cuts without congressional approval.
Dean, a longtime Obama supporter, is not the first critic of the IPAB. In fact, he is one of many who believe that the board’s power to cut doctors’ payment rates could – and eventually will – lead to worse care for patients.
Dean writes that the “nonpartisan Congressional Budget Office has indicated that the IPAB, in its current form, won’t save a single dime before 2021.”
He adds: “If Medicare is to have a secure future, we have to move away from fee-for-service medicine, which is all about incentives to spend more, and has no incentives in the system to keep patients healthy.”
For slightly different reasons, most Republicans also oppose the IPAB.
In May, as part of their campaign to block the Affordable Care Act’s implementation, House Speaker John Boehner (R-OH) and Senate Minority Leader Mitch McConnell (R-KY) declared that they would not make any appointments to the IPAB, whose members must be confirmed by the Senate.
“Because the law will give IPAB’s 15 unelected, unaccountable individuals the ability to deny seniors access to innovative care, we respectfully decline to recommend appointments,” Boehner and McConnell wrote in their letter to President Obama. Additionally, Senate Republicans have threatened to filibuster any IPAB nominee.
Dean is more concerned with the irony and probable ineffectiveness of the panel. According to him, the IPAB will never be able to actually control spending, and will merely create a “more bureaucratic” system that ends up driving up administrative costs.
The former governor of Vermont has quite a reputation with regard to health care. As a doctor (whose wife is also a doctor), Dean successfully implemented universal coverage for Vermonters under the age of 18 for almost two decades, and allowed families with a household income of less than $65,000 to buy into Medicaid. Under Dean, 96 percent of all young people in Vermont grew up with health coverage, and Vermont’s insurance costs have been significantly lower than those of Massachusetts, New York, and New Jersey for the past 18 years.