It seems hard to believe, but even now there are folks on the right concerned about “death panels.” The subject came up at a Paul Ryan event at the University of Central Florida over the weekend.
For those who can’t watch clips online, here’s a transcript by way of Igor Volsky:
QUESTION: We love you Paul. But I’m getting long in years. Will you address the death panels that we’re going to have?
RYAN: The death panels, well! That’s not the word I’d choose to use to describe it. It’s actually called. It’s actually called, so in Medicare, what I refer to as this board of 15 bureaucrats. It’s called the Independent Payment Advisory Board. It sounds fairly innocuous.
At which point, Ryan goes to argue that IPAB isn’t actually innocuous.
In terms of rhetoric, when Ryan says he’s not comfortable with the words “death panel,” I’m glad, but it’s worth remembering that this isn’t about semantics; it’s about policy. Those who talk about “death panels” aren’t just using the wrong language, they’re getting the substance wrong, too.
Asked whether “death panels” are real, the correct answer is, “Of course not.” For Ryan, the answer effectively boils down to, “Sort of, but let’s call them something else.”
Since IPAB questions still come up from time to time, let’s do what Ryan did not — set the record straight.
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.”
As we discussed in June, 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.
In theory, Republicans should be delighted, right? After all, we’re talking about a panel tasked with cutting entitlement spending and saving money. Why would Republicans say they want to lower costs and cut spending, then oppose a panel that would lower costs and cut spending? It has to do the GOP’s larger goal: scrapping Medicare altogether.
Both parties agree that Medicare faces long-term financial difficulties, and that addressing the problem is no easy task. Democrats have proposed measures like IPAB, which will limit unnecessary spending and lower overall Medicare costs, thus shoring up the program’s finances. Republicans have an alternative proposal: scrap Medicare, handing out vouchers that won’t keep up with rising costs, and telling seniors to get sick less often. The GOP opposes IPAB in large part, because they’re afraid the Democratic idea might work, and make the Republican goal of Medicare privatization that much less likely to happen. Since scrapping Medicare is the ultimate GOP goal anyway, IPAB’s efficacy would be a hindrance, not a benefit. Besides, it’s not like the 15 panelists serving on IPAB have some kind of dictatorial rule over Medicare coverage — the law not only gives Congress oversight authority over the panel, but it also empowers Congress to replace savings if lawmakers disapprove of what the board comes up with. The demagoguery surrounding this is ridiculous. It’s a shame Ryan is making the confusion worse. Postscript: If you watch the clip above, you’ll notice that there’s a running debt clock being used a stage prop. Perhaps it’d be worthwhile to remember that Paul Ryan voted for the Bush tax cuts, two wars, Medicare expansion, and the Wall Street bailout, and put all of the costs — every penny — onto the national debt.
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