When it comes to the Affordable Care Act’s Independent Payment Advisory Board, it’s generally the far-right that complains the loudest. This is, after all, the provision that extremists and professional liars false labeled the “death panels” part of the law. But today, it’s Howard Dean on the offensive.
Dean, in a Wall Street Journal op-ed Monday, called the Independent Payment Advisory Board (IPAB) “essentially a health-care rationing body” and said he believes it will fail.
“There does have to be control of costs in our health-care system. However, rate setting — the essential mechanism of the IPAB — has a 40-year track record of failure,” Dean wrote.
Before getting into this in detail, let’s briefly reap this relatively obscure part of the larger health care law.
As Paul Krugman explained a while back, “Arguably the most important thing we can do to limit the growth in health care costs is learning to say no; we cannot afford a system in which Medicare in particular will pay for anything, especially when that’s combined with an industry structure that gives providers a strong financial incentive to engage in excessive care.”
The Obama administration seeks to solve this problem through IPAB — putting the difficult decisions in the hands of qualified medical and health care professionals, free of the political process on Capitol Hill. And why is this necessary? In large part because Congress has failed so spectacularly in its ability to make these choices on its own.
There’s a certain irony to the right complaining so bitterly about this element of the system, since we’re talking about a panel tasked with cutting entitlement spending and saving money.
When Howard Dean, a former physician who expanded health care access as a governor and ran for president on a health-care-reform platform, complains about IPAB, a different kind of problem emerges.
There are three main areas of concern to consider. The first is political — as xpostfactoid noted, Dean “is a Senior Strategic Advisor and Independent Consultant for the Government Affairs practice at McKenna Long & Aldridge LLP.” If we translate this from inside-the-Beltway rhetoric to real English, it means Dean does lobbying work for one of the more powerful firms in D.C.
That Dean’s employer has health care clients that stand to lose money from IPAB is a relevant detail that the Wall Street Journal’s editorial board did not include for readers to consider. (In 2011, Salon asked the lobbying firm and Dean’s office for a list of his clients. They both declined.) Second, there’s ample evidence that challenges Dean’s assertions on the merits. Cost controls have a pretty good track record, and his Wall Street Journal op-ed offers no evidence to the contrary. And third, there’s the irony of Dean, of all people, pushing this argument in the first place. As Jonathan Cohn explained: More sophisticated conservatives make a more sophisticated version of the argument — namely, that IPAB might set payment policies in ways that ultimately reduce access or quality. I don’t happen to agree with that view, but it’s a legitimate argument and one that serious people can make. What’s weird is to hear it coming from Dean. After all, the whole point of the public option that Dean once championed so tirelessly was to introduce a government insurance plan that would help set payment rates. The idea was that government would end up paying less to the producers of medical care. Doctors, hospitals, along with device and drug makers would make less money. But the government would also spend less subsidizing insurance for people. It’s the same method of controlling costs that Medicare already uses, and that IPAB will reinforce. It’s something to keep in mind when Republicans argue in the coming weeks and months, “Even Howard Dean is complaining about ‘Obamacare.’”
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