Editor's Note: Mr. Gephardt represents clients in the healthcare sector. A list of his clients can be found here.
The Affordable Care Act (ACA) was a major accomplishment that will improve both our health care and our health insurance systems. The provisions to cover millions of uninsured Americans, end the practice of denying coverage for pre-existing conditions, institute delivery system reforms, and promote medical innovation deserve the support of all Americans.
As we all know, there is rarely such a thing as "perfect" legislation. President Obama recently signed into law the first significant improvement to the ACA: the repeal of the "1099 mandate" which Democrats and Republicans agreed would have placed an unnecessary burden on small businesses.
I have no doubt that the American people will stand firmly against efforts to undermine the law in its entirety, but as is the case with any legislation, there is room for improvement. I believe there is a step that's needed to continue to protect beneficiaries' access to Medicare services: the elimination of the Independent Payment Advisory Board (IPAB). Under the new law IPAB has been made responsible for suggesting and implementing cuts to Medicare. It is critical that Congress continue to be able to fulfill its duty to the American people and maintain direct oversight of Medicare on behalf of their constituents. Changes to Medicare's payments should be based on careful consideration of the Medicare program itself -- and not arbitrary budget targets.
Under the current law, IPAB will be an unelected and unaccountable group whose sole charge is to reduce Medicare spending based on an arbitrary target growth rate. It will propose cuts to Medicare that Congress can override only with supermajority votes, an unnecessarily high and unrealistic bar. Just as important, these cuts are likely to have devastating consequences for the seniors and disabled Americans who are Medicare's beneficiaries because, while technically forbidden from rationing care, the Board will be able to set payment rates for some treatments so low that no doctor or hospital or other healthcare professional would provide them. Certainly Medicare must be viable for current and future generations of seniors, but it would be wrong to achieve this goal by denying Medicare beneficiaries access to comprehensive and high quality health care.
The damage from large and arbitrary cuts to Medicare payments will likely extend beyond Medicare itself. Since 1965, Medicare has served as the baseline for health-care spending in the United States. There is the very real risk that private sector insurance payments will follow Medicare payments' downward trend until the under-65 population also loses access to care. The far-reaching impact of any of these consequences on Americans of all ages is so alarming that thorough, open Congressional evaluation and debate are essential.
In addition to threatening access, IPAB will negate the provisions in ACA that would otherwise improve health care delivery. These provisions include a heightened emphasis on preventive services and the incentives to coordinate delivery models that are designed to ensure that patients receive the right services they need, in the right quantity, and at the right time. Also of great concern to me is the possibility that untenably low payments will have a chilling effect on the research and development necessary to spur what promises to be the next great breakthrough in prescription drug treatment: personalized medicine, which would treat with pharmaceuticals and biologics tailored to an individual's genetic make-up. These are the very steps needed to lower Medicare spending in meaningful and sustainable ways, helping Medicare beneficiaries, the under-65 population, and our economy.
Democrats and Republicans have an opportunity to embrace bi-partisan legislation eliminating IPAB, thus giving direct oversight of Medicare back to Congress, and giving the policy-based payment reforms in the ACA a chance to work. This is the way to ensure continued access to care and lay the groundwork for the next phase of reform.
Members of Congress are elected to do their constituents' business and protect their interests. Serving as the stewards of Medicare is an important part of Congress' responsibilities. Representative democracy might not function as quickly as might be hoped and it certainly is not perfect. But creating an unaccountable board of unelected individuals, even if they are experts, to impose their will on the American people is far worse.
Former Rep. Dick Gephardt of Missouri served as a House Democratic leader. He is now president and chief executive officer of Gephardt Government Affairs.
http://www.washingtonmonthly.com/ten-miles-square/2011/06/tricky_dick_gephardt030469.php
See Washington Monthly article: http://www.washingtonmonthly.com/ten-miles-square/2011/06/tricky_dick_gephardt030469.php
Should be disclosed.
I was stricken with paralytic polio at age 6 and know firsthand what happens to entire families, when patients cannot enforce their rights. My family had no health insurance. Doctors and hospitals provided the best care at little cost. They told me that they hoped that I would repay them when I grew up by helping others in my situation. I promised to do so and kept my promise, with the help of the best husband in the world.
I became a federal fraud investigator. I worked to INSURE THAT NEITHER PATIENTS NOR DOCTORS WERE GAGGED by the government and special interests. Patients have a right to know all unbiased facts pertaining to medical decision-making to insure informed consent. Discrimination of any type, especially in medical care is repulsive.
I recall that African American child polio victims were sent to segregated hospitals and provided inferior care. The IPAB legitimizes rationing and discrimination against the middle class and the poor. Most Americans will always be one catastrophic illness away from poverty due to IPAB’s payment rationing.
Twenty-first century patient gagging by the California Department of Managed Health Care and Kaiser Permanente, with the help of the IPAB, will permanently destroy the doctor-patient relationship, affecting the free exercise of all patients’ rights.
Documented investigations are posted on http://www.hmohardball.com/Writ-GIN024734_2b001.pdf
and http://www.hmohardball.com
Jacquelyn Finney MPA
You Mr. Gephardt, tell us about IPAB that, "It will propose cuts to Medicare that Congress can override only with supermajority votes, an unnecessarily high and unrealistic bar."
I feel more comfortable with Congress being in that position than in a direct policy-deciding roll.
There ARE places to cut Medicare, and the IPAB will be charged with finding those places and taking action. For instance, test after test after test ordered by doctors just to avoid malpractice suits. Another for instance, the fly-by-night clinics that fraudulently bill Medicare and get paid millions before they are caught--and by then their operation is long gone.
Another for instance, not paying hospitals for additional costs and care that are brought about by their mistakes--infections due to bad hygiene practices, ordering wrong medications, operating on the wrong leg, etc.
Congress will not take the time to look into these matters and make recommendations or implement bills. Congress only listens to lobbyists to get their information. How reliable is THAT?
An independent body such as the IPAB is what's needed. Maybe they won't be perfect, but it's a start.
He (Gephardt) sounds awfully concerned, but why? We look for clues in the client list provided by Gephardt Government Affairs. And we see: the radiation oncology company Accuray, the Council for Medical Innovation, the Cyberknife Coalition -- which demonstrates its wares like this:
And we go on to eHealth, ISCON ("whole body imaging solutions without radiation"), pHRMA, and United Health Group.
Anyway, I'm stumped. Can we think of a reason Gephardt wants to get rid of IPAB?
Then see if the want to gut both programs.
Your suggestion would simply discourage poorer candidates from running, leading to an even higher concentration of "the rich" in congress, further removed from the concerns of the common man.
The applicable scope of the law of unintended consequences is truly breathtaking and should lead us all to curb our hubris, especially regarding political "solutions".
The entire act was sold as a cost containing measure, among other things. That board (so-called "death panels") was a fundamental part of how costs were going to be reduced (note that the Medicare Actuary doesn't even think it will reduce costs anymore).
How will it contain costs if you eliminate this board? Given congress' record on Medicare and Medicaid cost increases, how can you possibly argue that putting them in control will lead to anything other than a vast cost overrun?
A cynic would suspect that Mr. Gephardt's real goal here is to intentionally make the system more expensive, thereby leading to an untennable situation requiring a complete government takeover of the nation's health care industry.
Medicare and Medicaid are major and growing burdens on govts both at national and local levels. Affordable Care Act, encouraged by "Comparative Effectiveness Research", is providing science-based insights (published in medical and managed care journals) to more cost-effective care.
Will federal govt (Secretary of HHS) and states (Health and Insurance commissioners) encourage / mandate healthcare providers to implement these new pathways and start saving monies?
All stakeholders - Consumers (public, patients), Providers (doctors, hospitals, etc) private corporations (insurance carriers and pharmaceuticals) should proactively implement improved and cost-effective treatments; given that federal and local govts are drowning in red ink.
We can save 50% of healthcare cost through illness prevention (smoking cessation, weight reduction, exercise, etc), ending over-treatment and inappropriate treatment; not to mention ending waste, fraud and abuse in healthcare and billing.
We spend 17% of GDP on healthcare compared to competing Western countries (that provide care at 5% to 11% GDP and get better results). Hence there's much we can save and that govt can cut; while actually improving medical care.
Intersecting point for high cost care are hospitals. Through hospital accreditation organizations, work of the hospitals' Quality Improvement and Utilization Review committees should be closely evaluated for leadership and monitoring of proper care.
Hospital's Medical Directors are point persons, that could serve the community and ensure good medical care, but NOT simultaneously ensure 15% annual growth in hospital revenues through unnecessary ER visits and hospital admissions.