The Medicare “death panels” bogeyman is back, reintroduced by, of all people, Rep. Paul Ryan, the man who would reform the Medicare entitlement. What did Bill Clinton say about “brass”?
It was last month at the Republican Party’s happy hunting grounds known as The Villages, a retirement community outside Orlando, Fla., that the vice presidential hopeful told the assembled crowd that Obama “puts a board of 15 unelected, unaccountable bureaucrats in charge of Medicare, who are required to cut Medicare in ways that will lead to denied care for current seniors.”
Ryan is feeding seniors’ fears over rationed government care but fails to fess-up to all the rationing he has in store.
First, let’s sweep away misconceptions about the “Independent Payment Advisory Board,” (note the word “advisory”) to which Ryan is referring. This is a key Medicare cost-containment provision of the Affordable Care Act and a part of why the solvency of Medicare’s primary trust fund is eight years longer under Obamacare than without it.
Here’s how the board works: Fifteen experts in health care, including consumers and seniors — not government bureaucrats — appointed by the president but confirmed by the Senate, would be charged with finding new efficiencies in Medicare’s medical delivery and payment system. If increases in Medicare costs exceed a targeted amount — growth in the nominal GDP plus 1 percent after 2017 — the board must offer ways to rein those costs in. But the elected, accountable Congress has the last word. It can adopt the recommendations or reject them as long as it offers an alternative way to contain the rate of growth.
Contrary to Ryan’s claims, the board cannot ration care, raise taxes or premiums, or restrict benefits to bend Medicare’s cost curve.
This studied approach preserves Medicare’s safety net features while forcing Congress to be fiscally responsible, similar to the commission that helps close redundant military bases. It should be applauded by Ryan, who claims to be a fiscal conservative.
Except no true fiscal conservative would vote to put two wars, tax cuts for the wealthy and the Medicare prescription drug benefit on America’s credit card, or help scuttle the bipartisan $4 trillion deficit reduction deal from the Simpson-Bowles commission, or propose a fiscal plan that includes generous tax cuts to the rich and no balanced budget for at least another 28 years — all of which Ryan has done.