Pipe dream? Obamacare

[techno900]

Mac said:

[techno900]

swchandler said:

[isobars]

Especially now that Obama has unfettered authority to appoint any unvetted loon he wants to the panels that decide which patients and which treatments it will allow. It already curtails my knee rehab PT very significantly, and that will get much worse when the IPAB and its counterparts get packed with political appointees rather than practicing physicians.

[uwindsurf]

IPAB was created as a strengthened version of the Medicare Payment Advisory Commission (MedPAC), a body with no regulatory power that solely advises Congress, but can not enact regulations in and of itself. Since 1997, MedPAC had recommended cuts totaling "hundreds of billions of dollars" to Medicare that were ignored by Congress. Also, Congress has pressured Medicare administrators to cover "ineffective or needlessly costly methods of care", while Medicare's founding legislation says "Nothing in this title shall be construed to authorize any Federal officer or employee to exercise any supervision or control over the practice of medicine". Henry J. Aaron, a health care expert at the Brookings Institution, says that many observers see that some in Congress are "in thrall to campaign contributors and producers and suppliers of medical services" and most are not well enough informed to wisely use Medicare's buying power to reform health care. The idea behind the IPAB was to take power away from Congress (and special interests) in order to give it to those knowledgeable in health care policy.

On June 25, 2009, Senator Jay Rockefeller introduced the Medicare Payment Advisory Commission Reform Act of 2009, which would have changed MedPAC into an executive branch agency. On July 17, 2009, the Obama administration submitted to Congress a similar proposal called the Independent Medicare Advisory Council Act, which would have created an independent five-member executive council to make recommendations to the president. From June 17 to September 14, 2009, three Democratic and three Republican Senate Finance Committee members met for a series of thirty one meetings to discuss the development of a health care reform bill. During this period, Senators Max Baucus (D-Montana), Chuck Grassley (R-Iowa), Kent Conrad (D-North Dakota), Olympia Snowe (R-Maine), Jeff Bingaman (D-New Mexico), and Mike Enzi (R-Wyoming), met for more than sixty hours, and their discussions established the principles upon which the health care reform legislation that later passed was based. The Finance Committee included a provision establishing an independent Medicare advisory board in its health reform legislation, which passed the Senate on December 24, 2009.

IPAB is tasked with developing specific proposals to bring the net growth in Medicare spending back to target levels if the Medicare Actuary determines that net spending is forecast to exceed target levels, beginning in 2015.

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." The Department of Health and Human Services (HHS) must implement these proposals unless Congress adopts equally effective alternatives. The board is also required to submit to Congress annual reports on health care costs, access, quality, and utilization. IPAB must submit to Congress recommendations on how to slow the growth in total private health care expenditures.

Every year on September 1, IPAB must submit a draft proposal to the Secretary of Health and Human Services. On January 15 of the next year IPAB must submit a proposal to Congress. If IPAB fails to meet this deadline, the HHS must create its own proposal. Congress must consider this proposal under special rules. Congress cannot consider any amendment to the proposal that does not achieve similar cost reductions unless both houses of Congress, including a three-fifths super majority in the Senate, vote to waive this requirement. If Congress fails to adopt a substitute provision by August 15, HHS must implement the proposal as originally submitted to Congress.

A 2009 Kaiser Health News article predicted primary care doctors would likely see benefits from an "independent Medicare commission because the panel would be more likely to increase their fees and lower specialists' rates". While payment cuts to hospitals and hospices are off-limits until 2020, and clinical laboratories are off limits until 2016, physician fees may be cut unless a doc fix to Medicare's sustainable growth rate formula makes those cuts off limits. Other "savings would have to be found in private Medicare Advantage plans, Medicare’s Part D prescription-drug program, or spending on skilled-nursing facilities, home-based health care, dialysis, durable medical equipment, ambulance services, and services of ambulatory surgical centers". According to the New England Journal of Medicine, holding off creation of accountable care organizations (ACOs) is likely to be a bad long term strategy for physicians.

Critics of IPAB have charged that the board's cost-cutting mandate will inevitably bring about a reduction in care, despite the anti-rationing language in the bill. Congressman Phil Roe from Tennessee, a medical doctor, warned that IPAB will ration care through payment policy. American Medical News charged that the bill gives IPAB "unprecedented, dangerous authority to cut Medicare pay rates and strangle access to care." IPAB has frequently been denounced by its critics as a death panel.

IPAB is composed of fifteen members appointed by the President, subject to Senate confirmation. The Secretary of HHS, the Administrator of the Center for Medicare and Medicaid Services, and the Administrator of the Health Resources and Services Administration serve ex officio as nonvoting members. In making the appointments, the President consults with the Majority Leader of the Senate concerning the appointment of three members; the Speaker of the House of Representatives concerning the appointment of three members, the Minority Leader of the Senate concerning the appointment of three members, and the Minority Leader of the House of Representatives concerning the appointment of three members.

The first members appointed to the Board will be divided into three staggered classes in order to ensure that their terms do not expire simultaneously. Five will be appointed for a term of one year, five will be appointed for a term of three years, and five will be appointed for a term of six years. All subsequent appointments will be made for six years. A member may not serve more than two full consecutive terms. Individuals who are directly involved in providing or managing the delivery of Medicare items and services may not constitute a majority of IPAB’s membership.

The President of the United States must establish a system for public disclosure by IPAB members of any financial and other potential conflicts of interest. As it currently stands, no IPAB member may be engaged in any other business, vocation or employment.

Members will be paid at a rate described in Level III of the Executive Schedule that determines pay for senior executive branch officials. As of 2010 this is $165,300 per year.

[isobars]

Not now that Obama can appoint anyone he wants to ration health care.

[uwindsurf]

[swchandler]

Thanks youwindsurf for the clarity and factual background pertaining to the IPAB.

No worries about isobars. As we've found over time, all he can offer is the repetition of nihilistic nonsense being promoted by talk radio and other highly questionable sources. Just look at his last two vacant posts. When it comes down to offering real ideas or any meaningful contribution to the debate, he's hopelessly incapable and lost.

[keycocker]

Techno,
Does anyone think that the ACA is the solution to all our healthcare problems?
That is first time a conservative has ascribed that foolish idea to liberals as far as I know.

Did you think of that silly opinion yourself? Libs didn't.
You object to libs here misrepresenting your opinions and so do I.
Do you regularly do the same without realizing it?

[mac]

But Techno, you always reveal how poorly read you are. You post some right wing talk radio blather about social security and Medicare going broke, the Democrats having no solutions, and privatizing social security is the answer. All of those are factually wrong--and, as usual, you demonstrate no grasp of the actual complexities of the issues, or that there might be different opinions, and underlying facts. You keep screeching that you have set a high tone here with your relentless attacks (without facts and reasoning they cannot be called criticisms) on Obama and Democrats and thus should be immune from insults. Also wrong--your tone in defines the tone in response.

There are a number of different academic studies of Social Security. Depending on assumptions, it can be spun to have fiscal issues in about twenty years--or be sound forever. Projecting out beyond ten years, on fiscal and climate issues, is risky. Here's just one bit of analysis from outside the bubble, which puts your argument into the ash bin:

[keycocker]

This is an interesting factual take on these entitlements future.
I learned something from it. Thanks Mac.
I regret that such missives often come with a session of slapping someone around.
Along with Techno , I thought these programs were going broke too.