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‘We’ the experts

Among the many government entities that are created by ObamaCare, one is especially troubling because it is comprised of a group of unelected government bureaucrats who will make critical changes in how the nation’s seniors receive health care.

The entity, known as the “Independent Payment Advisory Board” (IPAB), has 15 members, all appointed by the president; and he is not required to appoint a politically-balanced board. It is supposed to make recommendations for savings in the Medicare program.  Medicare is unfortunately rampant with waste, fraud, and abuse and we can all agree that finding savings in the Medicare program is critical to keeping it solvent; but creating an “Independent Payment Advisory Board” is not the right way to solve Medicare’s problems. 

Each year, the chief actuary at the Centers for Medicare and Medicaid Services (who operates similar to an independent auditor) would determine the projected growth rate for Medicare. If that projection exceeds a target growth rate, IPAB must submit a cost-savings proposal to Congress and the president that meets that target. That means rationing care. An arbitrary monetary amount is set, and seniors’ care must be limited by that amount.

ObamaCare sets up a prescribed procedure for Congress to consider the board’s decisions — procedures that are designed to ensure the board’s recommendations almost automatically become law.  The procedures specifically bar Congress from considering changes to the proposal unless it’s able to find the same savings amounts as proposed by IPAB.  ObamaCare only allows this limitation on congressional action to be waived in the Senate by a three-fifths vote.  In other words, Congress must cut the same amount from Medicare, or find 60 senators to block the board-recommended cuts.  If it cannot do either, the Department of Health and Human Services must implement the original IPAB recommendations, regardless of congressional action! End of story.  

But it’s not just the process that’s a problem. There’s something more troubling.  As Wesley J. Smith wrote in an article entitled, “Our New ObamaCare Masters,” “When the Founding Fathers wrote the Constitution, they did not envisage governance by ‘we the experts.’”  True. So, contemplate the inevitable result of a new federal board of “experts” given the job of finding a certain dollar amount in cuts. While the law has language prohibiting the board from making recommendations to ration care, that is exactly what will happen. But, of course, cuts in seniors’ care won’t be called rationing. Instead, the likely approach, as in countries like Canada and Great Britain, is to delay doctors’ appointments, put some drugs and treatments off limits or rate allowable care by the life expectancy of the patient. The end result is a lower quality of health care – only that amount which will fit into the law’s “targets.” 

Because of all this, I have cosponsored “The Health Care Bureaucrats Elimination Act,” which will repeal the IPAB in its entirety.  

There are better ways to reduce the growth in Medicare expenditures by the government. For example, the budget written by Wisconsin Congressman Paul Ryan and passed by the U.S. House of Representatives would allow seniors to choose their own insurer (as with the drug benefit under Part D). To help defray their costs, the government would provide “premium support.” The new approach would not apply to those over 55 years of age.

There are other ideas as well, but the point is, we do not have to give 15 government bureaucrats the right to ration Americans’ health care.

— Jon Kyl, who was first elected to Congress in 1986, is serving his third term as a Republican senator from Arizona.

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