Return control to the patient

Editorial

"Who is in charge: the government or the patient?" U.S. Rep. Paul Ryan asked during a memorable speech about health care last month at the Hoover Institution, Stanford University.

For most of us, the answer is clear. The patient, in consultation with his or her doctor, should be in charge. But the new health care law's attempt to contain out-of-control costs would give the government that role.

The law creates a 15-member board — the Independent Payment Advisory Board — charged with reducing Medicare payments in years in which spending exceeds targeted growth rates. The IPAB would, as National Review suggested, "make Medicare worse for seniors while leaving in place all the program's perverse incentives, which distort the rest of the health-care market."

In short, Medicare patients would lose access to medical care when Medicare payments to doctors and hospitals are cut and physicians then refuse to take new patients.

"A (Medicare) card doesn't help if doctors won't take it," Dr. Donald Palmisano, former president of the American Medical Association and a spokesman for The Coalition to Protect Patients' Rights, a nonpartisan advocacy group, told us during a visit this week. "IPAB will just delay the inevitable. More doctors will go into concierge practices."

Congress need not wait for the Supreme Court to determine the constitutionality of the overall health care law to get rid of IPAB.

There is bipartisan consensus on Capitol Hill that IPAB is a mistake. Physicians groups don't like it, hospital lobbies don't like it, and even the American Medical Association, whose support helped pass Obamacare into law, has called for its repeal. Some Democrats, including U.S. Rep. Kathy Castor of Tampa, have signed on to Tennessee Republican U.S. Rep. Phil Roe's repeal bill.

IPAB's proponents, including President Obama, insist this is no rationing board and point to the section of the law that says there can be no rationing. But it is what it is. The health care law may not ration Medicare directly, but it gives the board the authority to ration Medicare in the future. If Medicare costs rise too rapidly, the board has the power to make "recommendations" to contain those costs, and Congress must go along unless it has a different plan to make the cuts or a supermajority overrides the recommendations.

In effect, the panel has the power to do what Congress has been unwilling to do: make painful cuts to Medicare.

Everyone can agree that Medicare costs must be contained and that the payment system doesn't work. But the threat of reduced payments to providers will result in rationed care, no matter how you look at it.

Amazingly, President Obama thinks IPAB should have even more power.

According to Ryan: "The president's latest proposal simply called for letting IPAB cut deeper. This board of bureaucrats will now be tasked with holding Medicare's growth rate to GDP plus half a percent. To put that in context, Medicare is currently growing at 6.3 percent per year.

"Medicare's non-partisan chief actuary, Richard Foster, has been clear on this point: Going from 6 percent growth down to the president's targets, using only the blunt tools that his law gives to IPAB, would simply drive Medicare providers out of business, resulting in harsh disruptions and denied care for seniors."

And, he aptly noted: "You cannot control costs by using price controls, which impose painful cuts within a fundamentally broken framework."

The board won't have control over individual patients, as presidential candidate Michele Bachmann suggested in debate this week. But its "top-down price controls" will drive physicians away and make it harder for seniors to find care. It should be repealed.