What IS the IPAB you ask? If you know the answer to this, you will score big points with your friends, because only about .5% of the population knows the answer. The IPAB is the Independent Payment Advisory Board established in the health reform bill to help keep Medicare spending under control. Sounds good, right?
Actually, almost everyone hates the idea of the IPAB. Everyone, that is, except more than 200 economists and health care researchers, the former head of OMB, Peter Orszag, and of course the president of the United States, who made the IPAB a central part of his deficit reduction proposal last week. In fact, he recommended strengthening not repealing it. The reason for the president's strong support is the conclusion reached by many economists that the type of decisions that need to be made about Medicare spending require independence and expertise.
Here's what the IPAB is, and why so many groups fear its power. The Board would be composed of 15 members appointed by the president (and subject to Senate confirmation). The members would be physicians, patients, the elderly, economists, health insurers, employers and researchers. This board would be asked to recommend ways to control Medicare spending, triggered by a certain percentage increase in Medicare costs each year. The recommendations of the Board each year must be approved by Congress in their totality unless Congress can come up with options for savings that are similar to what the Board has proposed. Sort of a "base closing" kind of up-or-down vote. There are safeguards for Medicare benefits, however.
With regard to IPAB's recommendations, the law says:
The proposal shall not include any recommendation to ration health care, raise revenues or Medicare beneficiary premiums under section 1818, 1818A, or 1839, increase Medicare beneficiary cost sharing (including deductibles, coinsurance, and co-payments), or otherwise restrict benefits or modify eligibility criteria.
There are many reasons why this type of Board faces opposition. Its independence from the political process is both an advantage and a disadvantage. It's an advantage because recommendations about reducing Medicare costs probably should be done by independent experts (including patients), not by politicians, who can be swayed by financial contributions and pressure from their health care constituencies. It's a disadvantage for the same reason. The IPAB would be largely independent of congressional control. Politicians do not want to give up the opportunity or responsibility to tweak Medicare, and both Democrats and Republicans oppose the Board for that reason. Many health industry and physician groups also oppose the Board because it could have too much power to reduce or change their rates of reimbursement. Consumer and patient groups have doubts about what the recommendations might do to patient care and coverage (even though the law forbids the Board from reducing benefits). Add to that the difficulty of coming up with recommendations for cuts when you cannot touch benefits or raise revenue, and you get the picture. This is not a popular program.
The arguments against the IPAB are both substantive and ideological. Republicans say that health care recommendations by the IPAB will be made by bureaucrats or "experts" you don't know (and would be a government takeover of course). Actually that's the way these decisions are made right now in the way Medicare is administered by private sector plans, and how is that going? Do you know the people in your insurance plan or in the Medicare bureaucracy who are making the decisions about your benefits? They may be bureaucrats, but is it comforting that they are "your" or "Congress's" bureaucrats? It is true that this Board would not be as accountable to the Congress as it would be to the president, but the IPAB is not completely without accountability given the opportunity for Congress to come up with its own solutions if it doesn't like what the Board recommends.
As members of the public and current or future patients or Medicare beneficiaries, should we hate the IPAB too? Should we oppose the idea? It all depends on where you think the authority for controlling the cost of Medicare should reside. If you believe that an elected official would make better decisions about Medicare spending, then you would oppose the IPAB. If you think appointed experts from a variety of fields of expertise, then you would support the IPAB. Whatever you believe, there will be plenty of hyperbole launched around this board in the next few months as the federal budget is debated. I personally believe that the IPAB can play an important role in helping to keep Medicare viable, and I think the president has taken a courageous stand in supporting it. Whether it will survive the budget negotiations in the coming months is not clear.
Follow Linda Bergthold on Twitter: www.twitter.com/lab08
Doug Schoen: The Independent Payment Advisory Board Could Be Obama's Achilles' HeelIndepend
1. You never use fiat-paper money, accounting, or a 'dollar figure' when it comes to treating human beings...the price-is-the-price.
2. Why not demand that a price list be posted in the doctor's office so that a health-care 'consumer' can shop around to look for the best price? ...that's basic common sense.
3. Like government contracts for the military, road construction grants, etc., it can do the same for health-care providers, medical equipment manufacturers, etc. and called a 'public option'.
4. IPAB is provide 'immunity' to the HMO insurance monopolies. It's better to just simply break up the monopolies and have smaller providers openly bid on government contracts.
5. Don't put a 'standard' on the 'cost' of health-care, instead put in place a standard on the 'quality'; demanding the highest quality, like you do for military aircraft.
Any social services provided to a nation's citizens is the hallmark of a civil society, however, it can only happen if the economy is productive.
Wall Street TBTF banking is not adding 'productivity' to the economy, therefore, they should be cut off from taxpayer support and backing by restoring Glass-Steagall.
Restructure the banks, CLAWBACK the bail out trillions and invest in a productive economy and then you will have plenty of means to distribute high quality health care to all.
1. Someone will take a look at specialty physicians using self-referral to order un-necessary CT, MRI's, Cadiolite Stress test that do nothing to improve care--but enrich the unqualified interpreters of these exams.
2. They may make the hospitals and docs eat the costs of increased testing, meds, and time due to infections and medical errors.
3. They may actually look at some Evidenced Based Medicine Reviews--like the Cochrane Review, and find out that most drugs don't work--or work poorly, that drug company research stinks--the wrong endpoints are measured, they are inconsistent and most of the reviews include statements like "more research needed", or not beneficial.
4. They may find out that all of the fraud committed against Medicare is by our "Private Sector" saviors. The Labs, the docs, the home health care companies, the hospitals, the clinics, the drug companies and Nursing Homes. Patients can't bill Medicare, but they are at the mercy of the PRIVATE sector, who want no regulation.
5. The gravy train will end for lots--not all.
The reimbursement schedules need to be flattened and spread horizontally to reward primary care physicians, internal medicine and geriatric care MD's with increased compensation to attract increased numbers of these types of doctors.
Thus, the spinal surgeons will have to suffer as they see their incomes decrease from current $1.5MM down to $750,000 per annum-however I think they'll be able to survive.
Procedure based specialtys and sub-specialtys will be rewarded less, and preventative care-more.
The Medicare payroll tax must also be increased by 1% across the board for all employees and self employed etc.
While I am remarkably anti-tax, nothing is free. It needs to be funded and paid for.
I also have no problem with retirees opting for and receiving a vouchure to go out and shop for their own custom plan if they so choose.
That should be an option made available to those millions who may wish to explore it.
If there is genuine competition amongst accredited healthcare providers and people can select their optional coverage in addition to required mandatory core benefits, than I'm all for it.
I would actually take the current Medicare payroll tax and transfer it to SS to keep it solvent. Create a national sales tax, or value added tax (don't care which) that pays for Medicare. Run it like a trust fund, but keep its balance sheet limited to no more than a few years of disbursements on hand.
This way, if people want to expand Medicare, you can sit down and come up with reasonable figures for how much the tax rate needs to go up. Everyone pays in, everyone who wants coverage can sign up, and make concrete cost-benefit decisions on changes to the system.
As far as the rest of your post, I am not a health care professional, but it seems to me as an outside observer that there is absolutely no reason why health care is so expensive.
Then again, when my son was born 17 years ago my wife's recovery room was a ward with a couple other ladies in it, and she stayed 24 hours. When my neighbor down the street had a kid last year, her recovery room was nothing less than a Hilton Hotel Room she had to herself, and she stayed for the better part of a week.
There are good arguments both for the IPAB and against it, but none of these arguments includes calling it a "death panel". Probably the most important challenge for the IPAB will be trying to get costs under control without touching benefits or cutting reimbursement to doctors and providers. If you have ideas about how costs can be controlled in other ways, please share them.
You state, "bringing costs under control without touching benefits or cutting reimbursement to doctors or providers". That statement reflects a complete and total abandonment of capitalist principles as they apply to the medical industry.
My goodness,people complain about attorney's fees, can you imagine how much lawyers would charge if consumers didn't have to pay them out of pocket. Can you imagine what they would charge if part of your employment benefits were payment whenever you wanted a lawyer.
Interestingly enough, lawyers are ethically chaged with providing free services. The government pays for a free lawyer for a person who cannot affort one. That's constitutional law. Many governments even pay for a free lawyer for poor people in civil cases.
If lawyers, cable T.V., and real estate brokers do fine in the capitalist system, why can't doctors?
Doctors whine and whine about how they are suffereing finanacially. They whine about malpractice premiums. But when they whine they never, ever, mention their gross income. They never ever mention the "honorariums" they get for shilling for drug companies. They never mention the fact that they receeive free all expense vacations from the drug companies for "educational programs". They detest lawyers and litigation, yet they never mention that they charge $500- $1000 to testify as "expert witnesses", They whine about their student loans, but never mention how heavily subsidized their eduction was.
Same medication, same dose, same manufacturer. One quater cheaper in Canada.
http://www.nytimes.com/2011/04/20/us/politics/20health.html?_r=2&partner=rss&emc=rss
http://www.nationalreview.com/corner/264988/ipab-obama-and-socialism-stanley-kurtz
:-)
If there aren't enough cardiologists in an area for example the price to see one will be high. That provides incentive for more cardiologists coming to the area. More coming lowers the price for everyone until you reach the point that it isn't worth it for more to come. That sort of thing happens in all parts of an economy and in each geographic area. Economies have moving parts. A centralized board can only screw things up and it can't help areas that need to attract more cardiologists or more of whatever the area is short of.
But seriously, all of that "market force" stuff gets thrown out the window when the government starts paying the bills. As my 86 year old Grandmother told me in the car the other day, "Anything the government gets involved in becomes a racket".
To expound on that, the government should either be the dominant force, or a very meek force. Right now the government is paying for something like 60% of all the medical care in the US (I know that number is wrong, but I also KNOW that someone will correct me). But its not pushing the market around, its merely accepting what is thrown at it. The government, using our tax dollars (and oh by the way, its citizens good credit to go out and borrow money), is THE dominant force in the market, but wants to act as if its merely a disinterested observer.
The government needs to either be ALMOST all in on health care, or needs to get ALMOST entirely out of it. The current paradigm is just plain stupid.
If you look at what other countries are doing and the polling on people's satisfaction with their system they are pretty similar to ours. I think it would be a mistake to allow the government to take it over completely. The average doctor in the UK makes $60,000 per year(that is American dollars). You would be hard pressed to find people willing to go through the schooling, residency programs(modern day indentured servants), etc... necessary to be a doctor today when if at the end of all that they would be paid only $60,000 on average. So we will end up seriously decreasing our requirements to become a doctor or seriously decrease the calibur of person who becomes a doctor if we go down that road.
Private insurance pays much more than medicare and his allows hospitals and doctors to treat the unisured or Medicare for less. FALSE!
Once true, but NOT in the last decade.
We have no cases were private insurance rates in our cancer treatment centers were higher than medicare and 90% of the time they are lower by upto 30%( as in the case of the Private Medicare Advantage HMOs( unfunded, cost gov 15% more, set up under BUSH) and that spread to what they would pay for their non medicare insurance).
Pls note they add 40% more overhead than medicare, then routinely dont pay for approved treatments and they go bankrupt!
70% of DOCs what medicare for all, 80% of all healthcare workers... there is a reason!
Add to that 57% of Fortune 500 execs want medicare for all. inorder to compete with companies in other countrieswith better/cheaper single payer and who wants the cost of running a health insurance department
Private insurance companies contracts with providers are largely a percentage of Medicare rates. So if medicare goes up, private insurance reimbursemebt rates go up.
Why do you think repugs tried to block medicare rate increases so decreases would come into effect for the last 2 years.. automatic windfall profits to insurance companies, yet at the same time saying we cant go to medicare for all because medicare pays too Little.
Regards
"ANOTHER PRIVATE INSURANCE MYTH"
- and not immediately insulted a person (Republican, but a person noetheless) who might be inclined to agree with you, or at least take the time to understand your arguments.
Regards.
Very little Regards.
But Regards nonetheless.
P.S. If the government was all in all health care, it WOULD make our industries more competitive on the world market.
Whether through the federal government, or by YOU-the Consumer-as you select what level of care and type of care options fit your needs best.
The only real question is, WHO do you want to be in charge of making these decisions and choices for you?
A government Panel or Board in Washingto DC?
Or you-yourself?
I choose me.
Provide me with a stipend, and I can opt out of pychiatric services, abortion serices, chiropractic coverage, no dependent care etc.
And if healthcare companies have to compete for my stipend
Will I have better care options and choices and cost control?
Of course I will.
■ Total spending on health care would rise from 16 percent of gross domestic product (GDP) in 2007 to 25 percent in 2025, 37 percent in 2050, and 49 percent in 2082.
■ Federal spending on Medicare (net of beneficiaries’ premiums) and Medicaid would rise from 4 percent of GDP in 2007 to 7 percent in 2025, 12 percent in 2050, and 19 percent in 2082.
Pls note the the private sector healthcare cost rise more than Medicare does.. which is covering the oldest and the sickest and with the Babay Boomer budge entering into medicare.
And given how many people go w/o insurance and needed treatment prior to medicare (such as Knee replacements or a hip and other untreated conditions) come into Medicare including those that had insurance, perhaps not good insurance , with high deductables so they avoided checkups or were simpley afraid that if a checkup found some thing, it was grounds for trippling their insurance costs or being dropped from insurance!!!! NOW THATs a WONDERFUL system! NOT. Thus Medicare gets hit picking up the cost of the health insurance companies increasing thier profits.
Healthcare facts:
http://www.visualeconomics.com/healthcare-costs-around-the-world_2010-03-01/
Regards
Have owned and operated cancer treatments in Florida for more than 15 years.. closing down now.
It has been a decade since we have seen a private insurance rate higher than medicare. The Private insurance medicare Advantage programs pay 30% less than medicare and that has spread to the regular commercial insurance plans.
And while insurance companies trippled premiums , reimbursements declined 30%!
Repug say Medicare cost too much, but then they say we cant go to Medicare for all becuase it reimburses to little.
Makes one's head spin and neither are true statements.
Every insurance contract we have signed in the last decade is based on a percentage of Medicare rates... then we have the 40% additional overhead above Medicare they add, their not paying claims that they happened to approve or going bankrupt after they owe us a million or so..
Think how much a huge business is willing to pay to distribute false facts, paid for posters to try to justify their existance, when their is no no need for health insurance companies. Would Walmart pay a middleman 35% , that then added 40% to their cost and stay in business?
Medicare could reduce some specialist fees and shift that to primary care physician rates.
Hospitals, physician offices can have bad debts as high as 30%... Medicare for ALL does away with that large costs.
Regards