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Howard Dean: Opposing IPAB Is ‘Something Democrats And Republicans Ought To Agree On’

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Howard Dean: Opposing IPAB Is ‘Something Democrats And Republicans Ought To Agree On’


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.


  1. docb July 29, 2013

    He and his wife are doctors..We do not like oversight but this is about driving costs down!

    1. Ford Truck July 30, 2013

      Someone NEEDS to drive costs down!! Recently, while on vacation, I had an eye irritation that was causing itching, redness and a bit of swelling. Being away from my own doctor, my wife insisted I go to a local hospital emergency room.

      After I had signed in, a nurse came to the waiting room to get me, but looked at my eye, and told me to wait there. Three of four minutes later, a doctor came out to the waiting room, shined a light in my eyes, wrote something on a chart, and told me “You have simple conjunctivitis, I’ll write you a prescription” and he walked out of the room. I was in an out of the emergency room in 15 minutes.

      I went to the local Walgreens and was charged $142 for 2.5 milliliters (about 1 teaspoon) of eyedrops.

      When we got home and read the mail, I found I was billed $1,250 for the emergency room, which I never saw; $648 for lab work, although they never took any samples to test; and $450 for the physician’s service, which took all of 30 seconds.

      Next time I need to go to the emergency room, I’m going to take my own Vaseline so they can’t charge me for the lube before they F— me!

      1. docb July 30, 2013

        That is exactly why there needs to be oversight, truck! Your experience is not out of the ordinary..Get a patients advocate!

      2. latebloomingrandma July 30, 2013

        Wow! And the right screams louder and louder about not ruining the best health care system in the world. Three years ago, my sister and husband were visiting in Wales, where they have that “evil” National health care system. Her “trick knee” went out and her husband took her to the “surgery”, their name for the ER. She gave her name and date of birth. They took an x-ray, an orthopedic doctor told her the knee was dislocated and he would put it back in place. They gave her a little nitrous oxide, popped it back, then applied a brace, gave her crutches , and a copy of her x-ray on disc to take back to her doctor in the states. Length of stay —an hour and a half; no charge.

        1. disqus_LcxpBv2uzz July 30, 2013

          A few years ago, my wife and I were traveling in Italy. My wife tripped, fell and cut her knee pretty badly. We went to Pronto Soccorso (“fast care”, i.e., the ER at the local hospital). The doctor cleaned the wound, disinfected it and wrapped it; and told her to check back the next day. She went back, the doctor changed the dressing, and away we went. Total time for these procedures: maybe 2 hours. Total charges: nothing! Oh, the horror of “socialized medicine”.

      3. Justin Napolitano July 30, 2013

        Thank you for giving us an example of why Obamacare is so badly needed.
        I hope your insurance, if you have some, intervenes in your behalf.
        I would not pay that bill and would tell them to show you the results of the “lab work” Show you what examining room you were in and who the Physician was and how much time he thought he spent on his diagnosis.

  2. FredAppell July 29, 2013

    Why couldn’t Howard Dean win the presidency in 2004? We would already have a much different healthcare system in place than the one that is about to begin.

    1. latebloomingrandma July 30, 2013

      And to think he dropped out because he gave an exuberant scream. Eight years later we had a real Republican clown show, and made Dean look quite sane and real, rather than phony baloney.

      1. FredAppell July 30, 2013

        I rest my case!

      2. 4sanity4all July 30, 2013

        Yeah, I never understood why the press conflated that into such a big deal that it killed his campaign.

  3. Dominick Vila July 30, 2013

    Does Howard Dean also support deregulation because industry can police itself? The rationale for IPAB is to assess the strengths and weaknesses of ACA and make adjustments as required.

    1. Allan Richardson July 30, 2013

      Dean is a progressive with regard to industries other than his own. Well, since he no longer has a position in government, he has to fall back on his doctoring, right? What happened to the Dean who wanted single payer?

  4. Catskinner July 30, 2013

    Howard Dean his finally recognized the “Death Panels” that Sarah Palin pointed out when this entire discussion first got started.

    1. Joseph Squerciati July 30, 2013

      You think the present system doesn’t have death panels they are just called boards of Directors . Why we can’t follow the lead of every other industrialized country and provide universal health care is beyond my understanding

      1. ralphkr July 31, 2013

        Actually, Joseph, I came in contact with a ‘death panel’ in 1998. My mother had had a massive stroke and was unresponsive. One day a nurses came up to me and said that the doctor wished to speak to me about my mother. The man would have been cast in a movie as a doctor (clean cut, great voice) and he kept telling me that I was putting my mother through a great deal of pain and that there was no possibility of her getting better. I agreed to terminate extra-ordinary care (if I was in the shape my mother was I would certainly want the plug pulled). After my mother died I found out that the ‘doctor’ was not my mother’s doctor but that he worked for her insurance company and his job was to get patients terminated…so, a one man death panel.

  5. commserver July 30, 2013

    Penny wise Pound fooolish.

    There doctors who limit the number of patients with Medicaid. This means that they go to the hospitals.

    In the end we all pay.

  6. Justin Napolitano July 30, 2013

    The IPAB has no power to make changes of any kind. This board can only make recommendations but has no legislative or agency ability to make or enforce policy.

    It makes recommendations; Get it?

  7. Justin Napolitano July 30, 2013

    Dean is a doctor and if you have ever known one, personally, you know that they think they know everything on every subject. He is bitching because he doesn’t want anyone or anything questioning his procedures or what he charges. That is what IPAB supposed to do question everything medical.


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