A small army of health policy wonks helped Democrats pack ObamaCare full of big ideas that they hoped would transform American health care, making it less expensive and more effective. Perhaps the biggest of those ideas is IPAB, the Independent Payment Advisory Board, a 15-member panel of bureaucrats appointed by the president and tasked with holding total Medicare spending to predetermined spending targets. The panel’s name suggests it’s merely an advisor to Congress, which has traditionally been in charge of Medicare spending, but its “recommendations” have the force of law unless Congress holds down spending enough to meet the target or eliminates the board, which it can only do with a supermajority vote in the Senate.
Death Panel, right? Was Sarah Palin correct?
…IPAB is intended to take tough decisions about Medicare spending out of the purview of politically motivated legislators and turn those decisions over to a board of independent, unelected bureaucratic experts. Health wonks, in other words, convinced Congress to put a panel of health wonks in charge of the nation’s biggest health insurance program.
In a major speech on the federal debt earlier this year, President Barack Obama took this big idea and proposed to make it bigger by tightening IPAB’s official spending targets. Spending control and reduced political liability for Medicare cuts—what’s not to like?
We once had a conversation with a middle-aged British couple, who explained that although their community in England had overwhelmingly voted for such-and-such, the bureaucrats overrode it. The opposite to the vote was instituted.
How many times have your heard your friends on the Left bemoan the fact that the US isn’t more like Europe? We don’t have six weeks of vacation. We can’t retire at age fifty. We aren’t cultured enough.
The trade-off for all of this is Liberal Fascism, the State taking over the role of the voters:
But according to Cohen, IPAB’s mandate is so broad, and the checks on it so few, that it tests the limit of even the most deferential standard. “It’s like the perfect storm of bad elements,” she says. Among the problems? “Overly broad delegating authority language, no judicial review, no administrative review, no rule-making. There’s no meaningful congressional oversight and it’s not repealable except for under the most draconian and limited circumstance.”
That’s the other catch: ObamaCare doesn’t just create IPAB. It also sets in place a series of barriers designed to make it extremely difficult to repeal. So if Congress wants to get rid of IPAB, it will have to jump through a complex set of hoops first.
During the Bush years, liberals fretted that we were “losing our liberties”.
That means acting swiftly and with great unity. The health care overhaul contains a provision labeled Joint Resolution Requirements to Dissolve the Board that lays out exactly the steps that Congress must follow if it wants to take down IPAB. The provision lays out in great detail what a joint resolution to dissolve IPAB would have to look like, and then sets out a further requirement that it must be introduced between January 1 and February 1, 2017—meaning Congress would have to act in just a few working days.
Following the introduction of the legislation, Congress would have to pass the joint resolution with a supermajority of sworn members by August 15 of the same year. “If you don’t do that,” Cohen says, “Congress has no option, at all, to repeal the board.” Meanwhile, even if the board were successfully dissolved, IPAB would keep issuing its recommendations, which would still have the force of law, until 2020.
The protections erected around IPAB make it all but impossible to repeal. “We kind of joke about that,” says Cohen, “the idea that the whole bill comes down but the only thing that stays is IPAB, like the roach after the nuclear blast.”
IPAB supersedes any changes made to Medicare, and in fact, IPAB trumps Congressional authority. Congress will not be able to institute any other system, because the rules of IPAB take precedent and cannot be overturned.
So, to all those liberals who dreamed of a European system, welcome to Paradise.