It has been some months now since liberals had themselves an orgiastic field day over conservative fears that Obamacare included what were unfortunately nicknamed Death Panels. The discussion, and the issue, died when our oh-so-political president, ever with his finger diligently testing the political winds, decided to drop the controversial Advance Care Planning Consultation proviso of the original Obamacare proposed legislation.
But now, like the mythological Phoenix, the issue has shaken off its ashes and once more taken wing; this time as part of the administration's plan to "reform" Medicare, which in turn is a part of their proposals aimed at achieving reductions in the federal deficit. Dubbed the Independent Payment Advisory Board (IPAB), this time, according to an opinion piece written by Andrea Tantaros and published in The New York Daily News, the panel will consist of, “15 unelected bureaucrats who will have unchecked, binding power in the interest of supposedly greater efficiency and lower costs. That means that instead of you or your doctor making decisions about your care, a group of Washington micromanagers will do it for you.” According to the plan, savings will be achieved by slashing reimbursements to physicians and hospitals and by restricting end-of-life patients' care by means of predetermined cost caps.
Opposition to the IPAB proposal is bipartisan; Rep. Peter Stark (D-CA) termed the Advisory Board a, “dangerous provision [that] sets [Medicare] up for unsustainable cuts.” Rep. Allyson Schwartz (D-PA), vice-chair of the New Democrat Coalition, wrote to her colleagues calling on them to support repealing IPAB altogether.
Plus ça change, plus c'est la même chose.
Article comments
— go to most recent comments1 - Irene Athena
Clavos, I'm glad to hear that Democrat Reps. Stark and Schwartz are standing in opposition to the latest incarnation of the "really-it's-not-a-death-panel"-death-panel.
Here's to many more flare-ups of across-the-aisles sanity in Congress.
2 - Glenn Contrarian
Clavos -
"...instead of you or your doctor making decisions about your care, a group of Washington micromanagers will do it for you.” According to the plan, savings will be achieved by slashing reimbursements to physicians and hospitals and by restricting end-of-life patients' care by means of predetermined cost caps.
BUT according to the White House:
* 15 experts including doctors and patient advocates would be nominated by the President and confirmed by the Senate to serve on IPAB.
* IPAB would recommend policies to Congress to help Medicare provide better care at lower costs. This could include ideas on coordinating care, getting rid of waste in the system, incentivizing best practices, and prioritizing primary care.
* IPAB is specifically prohibited by law from recommending any policies that ration care, raise taxes, increase premiums or cost-sharing, restrict benefits or modify who is eligible for Medicare.
* Congress then has the power to accept or reject these recommendations. If Congress rejects the recommendations, and Medicare spending exceeds specific targets, Congress must either enact policies that achieve equivalent savings or let the Secretary of Health and Human Services follow IPAB’s recommendations.
So according to the White House, the IPAB is specifically prohibited from doing anything that would 'ration care', 'restrict benefits', or otherwise modify eligibility for Medicare.
This, Clavos, is another example of conservatives wanting to throw the baby out with the bath water. Instead of looking at a system that has both good and bad components and then then keeping the good while fixing the bad, the conservatives just want to just get rid of Medicare as we know it.
That is, except for the older conservatives and Tea Partiers who say, "Keep your guv'mint hands off my Medicare!"
3 - zingzing
clavos, don't quote the ny daily news if you want to get a fair shake. it's not as bad as the post, but it's still pretty much a rag that no respectable journalist should find themselves writing for for too long. it does have some clever puns on its covers though, although usually not as good as the post.
as glenn points out, it's not rationing, it's not death panels, it's conservatives going bonkers over jack shit, as usual. i'd think y'all would love this... no raising taxes, increasing premiums, restricting benefits... sounds like another weak-ass obama compromise on healthcare.
take your victories where you can and don't complain about them, or maybe someone up there will figure out they're letting you win.
shhh, clavos... shhh....
4 - Clavos
Glenn,
Where in my article did I say I wanted to get rid of Medicare?
Nothing you posted refutes the characterization of "15 unelected bureaucrats...", who will be APPOINTED by the White House.
You quote, from the White House press release:
* IPAB would recommend policies to Congress to help Medicare provide better care at lower costs. This could include ideas on coordinating care, getting rid of waste in the system, incentivizing best practices, and prioritizing primary care.
In quoting this, you obviously do so with the assumption it's the truth and that it won't be changed after implementation. Neither is a good assumption where politicians are concerned and particularly in the case of the current denizen of the WH. When their lips are moving, they're lying.
Just exactly what is the meaning of "incentivizing best practices?" It sounds downright Orwellian.
For example, the Kaiser Family Foundation, an independent source, notes:
"Unlike the MedPAC commissioners, the Board members, as full-time federal employees, cannot engage in any other business, vocation or employment. Thus, it would appear that medical professionals, patient advocates, or policy experts who are otherwise employed on a full time basis would not be permitted to serve on IPAB."
And regarding the savings to be obtained, KFF further notes:
"While IPAB is generally required to make recommendations to lower growth in Medicare spending if the growth in per capita spending exceeds the target growth rates, the law imposes a limit on how much savings it can achieve, expressed as a percentage of total program payments, known as the applicable percent. The applicable percents, or maximum savings, for 2015 and subsequent years, are as follows:
Implementation Year -- Applicable Percent (Maximum Savings)
2015 -- 0.5%, 2016 -- 1.0%, 2017 -- 1.25%, 2018 and later -- 1.5%.
This means the ACA does not require IPAB to recommend proposals to keep Medicare spending below target growth rates; instead, it requires IPAB to reduce Medicare spending by the amount of the excess over the target but only up to the specified applicable percentage for a particular year." (emphasis added)
And in its conclusion, KFF further notes:
"IPAB evolved from a long history of concern about Medicare spending and Medicare governance, and like any major change in a public program, it raises issues to deal with in the future. IPAB continues to be the source of some controversy. Some groups are pushing to repeal IPAB even though they support other provisions of the ACA, and are pressing for implementation. Others see great promise in IPAB, particularly given concerns about the future growth in health care spending. Looking to the future, a number of questions are on the table. Will IPAB’s role be strengthened so it can play a greater role in efforts to reduce the federal deficit and slow the growth of Medicare and other federal health care spending? Will IPAB be operational by 2013, and if so, will Congress make any changes to modify its structure and authority between now and then? Will IPAB be repealed despite strong support among key policymakers?"
And finally, more than a few observers are concerned that the IPAB's real purpose is not to effect savings. Many are concerned that what will really happen when IPAB is in place, as American Thinker points out, is:
Again from whitehouse.gov:
"Congress then has the power to accept or reject these recommendations. If Congress rejects the recommendations, and Medicare spending exceeds specific targets, Congress must either enact policies that achieve equivalent savings or let the Secretary of Health and Human Services follow IPAB's recommendations."
When Medicare and Medicaid costs threaten to burst through the statutory ceiling, triggering action by IPAB, Congress will be faced with a Hobson's choice. IPAB can, and likely would, set the bar quite high for Congress by recommending huge cuts, using grossly inflated savings numbers, and making any equivalent cuts by Congress politically impossible to pass, resulting in certain inaction. Remember, every member of IPAB will be an Obama nominee, beholden to an administration with a laughably poor track record of veracity regarding fiscal matters. The pressure on IPAB to operate as a purely political instrument will be tremendous, if not irresistible.
Inaction on the part of Congress will effectively cede control to IPAB and HHS, leaving the administration unopposed in its effort to expand government control over the health care economy. Should Congress summon the courage to actually pass cuts equivalent to IPAB recommendations, the political fallout would be devastating. Either scenario plays to Obama's favor, and it is the purpose of IPAB to bring this about...
To understand IPAB and its intended role, it is essential to realize that ObamaCare isn't about health care, nor is IPAB about controlling costs. Both are mechanisms for building dependent constituencies, hopefully sufficient to provide the left electoral success for decades to come.
IPAB plays the role of goading agitator -- pitting groups dependent upon government largesse against those citizens from whom the government derives its funds. IPAB will demand, and Congress will reliably evade the tough decisions they were elected to make while bleating plaintively about their hands being tied by bureaucracy.
You're too easy, Glenn, probably comes from being a military lifer -- you're not supposed to question orders -- but I was a draftee, they didn't have enough time to brainwash me; you need to challenge authority more.
5 - zingzing
"To understand IPAB and its intended role, it is essential to realize that ObamaCare isn't about health care, nor is IPAB about controlling costs. Both are mechanisms for building dependent constituencies, hopefully sufficient to provide the left electoral success for decades to come."
ok. look. you accuse glenn of not believing what the white house has to say, even though those are short, declarative sentences clearly outlining the goals and limitations of the thing in question. fine. you can do that.
but then you (presumably) swallow obviously slanted conjecture about the future and the consequences of legislation that hasn't even been passed yet, without reading the not yet enacted legislation yourself. do you not see the problem?
first, you got "death panels" out of it. then, we heard all about "killing grandma."
if you want anyone to believe that, you'll have to convince people that obama would like to pull the plug on your grandma once she gets too expensive. hospitals might as well be stocking up on windex. injecting terminally ill patients with window cleaner sounds like your idea of what the democrats are attempting here.
or, at i posit this just so you might consider thinking for yourself rather than on right wing media, you might want to realize how ridiculous this all sounds. healthcare has become a democratic plot for electoral domination and they're willing to kill your fucking grandma to do it? does that sound like reality, or a republican horror movie, concocted by someone not all there?
6 - zingzing
hrm... last paragraph should start, "or, and i posit this..." and later in the same sentence should contain the phrase "rather than DEPEND on."
fingers not connected directly to my brain it seems. into surgery i go. i'll be better.
7 - zingzing
sigh... second paragraph... take out that first "not" and insert something like "too easily."
i'm just sorry. i've been editing shit all day and it's... fuck. whatever.
8 - Cannonshop
Windex? Glenn, have you priced that stuff lately? Not to mention the trouble with FDA over using Windex IV's...The truly progressive strategy, as seen in Britain and other NHS systems, is just to put granny on a waiting list...somewhere near the bottom, and reset it until she's decently dead.
9 - zingzing
my name's not glenn.
"Not to mention the trouble with FDA over using Windex IV's..."
eh?
10 - Clavos
Heh. Funny, Cannonshop.
11 - zingzing
"Heh. Funny, Cannonshop."
but how accurate is it?
12 - Cannonshop
#11 I'm pretty sure that FDA would object to the use of an ammonia/alcohol mix as a blood supplement, esp. at the concentrations found in generic brand windex-like fluid. OTOH, it's a crime in england for a doctor to, say, perform a transplant "off the registry" (meaning, without submitting to the waiting list and allowing his patients to be chosen by the NHS.)
EVEN in the event of a voluntary donor-the waitlist comes first and foremost above the surgeon's discretion.
It's one of the reasons for "Medical Tourism" from Europe to the United States. A similar system here, would likely be forced to accept the same sorts of compromise Britain's does-i.e. you can't have the doctors moonlighting with paying customers and still justify your national-socialist medical programme.
(and the word choice in that last sentence? totally intentional.)
The Bureaucratic way to avoid dirty-handed killing people, is to defer and delay until the "problem solves itself".
i.e. feed the terminal cancer patient morphine until he finally dies, because that's cheaper on the agency budget, than actual...y'know, treatment and shit.
13 - zingzing
hrm. what treatment do you really suggest for terminal cancer beyond pain medication? and are you sure that's all they offer over there, or are you just bullshitting? you're bullshitting.
i know the british system is a little fucked. it's fucked over here as well, especially if you can't afford nice insurance. sure, they might cure you, but they might ruin you.
really, if people were dying left and right from treatable diseases/problems, do you think such a system would last long? or do you think you're overstating your case?
i'm sure there are examples of medical malfeasance coming out of england, but there are examples out of here as well. if you're going to pay to get fucked, why not pay up front instead of leaving your family with the crushing debt?
why do you want to fuck your children!?
14 - zingzing
"I'm pretty sure that FDA would object to the use of an ammonia/alcohol mix as a blood supplement, esp. at the concentrations found in generic brand windex-like fluid."
when obama is king, what will it matter? the fda? pshah. all praise barack, lord and master, who can do all that he pleases. i will kill my own grandmother if she costs too much for the gov't. i will slip inside her hospital room, and with the thought of the great barry upon my mind, a syringe in my hand, and a bottle of windex in my grocery bag (and maybe a bottle of whiskey what with to steel me for the murder i'm about to commit--one must be bold, one must be cold), i will dip the syringe into the windex, draw it up, neglect to push the air out, because who cares at this point, find my grandmother's vein, and do her in.
all in the name of our great leader.
the revolution is complete.
freedom and liberty are meaningless.
they are stricken from the dictionary.
newspeak and obama reign.
15 - zingzing
it's funny. on one hand, cannonshop, et al, want to reduce wasteful gov't spending (yay!). on the other, he wants them to promise not to cut off gov't funding for terminal patients (yay!).
there's this girl named marie. she's cute, and rich.
she doesn't like to make hard decisions, so she bubbled up and lost her head and voiced a rather naive, ignorant opinion that tries to play both sides, but landed with a thud.
true story. lots more blood though.
16 - Clavos
I'll have some of what yer smokin', zing...
17 - zingzing
pure virginia tobacco. finest stuff. but i'm just riffing (at least in #14,) on what, apparently, the right believes of the left.
now, if you want a hit of this fine crack rock, you just ring my bell. stuff will get you going for hours. and it's so cheap... republicans should be all over this stuff. if you wanna get a job done, and you wanna get it done cheap, and that job is getting high, then crack is the answer. imma bout to make whiskey out of grandma's urine. it MUST BE DONE. only because it can.
18 - Cannonshop
#15 Actually, Zing, the problem is that while I'd love to protect those patients, I also realize that Government can't do the job, and likely won't do it if asked (though, bless their dimwitted hearts, they'd try a bit before settling down to normal business.)
in a very cold-blooded fashion, I have to tell you, a medical system that will at least TRY to cure something, is better than a bureaucracy that will just make you slightly more comfortable (and considerably more loopy) while waiting for you to die.
Expensive treatments tend to get cheaper if they work on a consistent basis-fifty years ago, nobody'd heard of MRI machines because they weren't invented (or at least, in mass production) yet. They're down to a point where even little towns like Durango Colorado have them, and likely will go down further. Arthroscopic Surgery used to only be for rich Atheletes, now it's common enough that you can have it and walk out the same day, the various vision-correction surgeries built up around Radial Kerototomie (spelling?) are common enough that clinics that specialize in them (and the more exotic Lazer based variety) advertise on the radio.
My stepdad got Arthroscopic in his heart, with a little balloon to re-open the internal arteries-a surgery that cost a fraction what an open-heart version that does the same thing used to cost.
Most of the stuff I just mentioned got cheap here, before migrating back across the pond, yet people with heart problems that are easy to treat in the U.S. (and cheap-relatively) die of those problems untreated in the NHS systems of Europe.
Market pressures here in the U.S. push those prices down and reliability up-some things you needed a specialist with extra degrees to get fixed fifty some-odd years ago, they let a medical tech with far less expensive an education do now-and they work BETTER than the treatments devised back then...in the United States.
You want cutting edge treatment, yeah, it can financially ruin you...but alive and ruined can be recovered from, dead is still dead.
19 - zingzing
"Government can't do the job, and likely won't do it if asked [...] I have to tell you, a medical system that will at least TRY to cure something, is better than a bureaucracy..."
we're talking about medicare here. it's gov't run. am i missing something? do you want to stop funding for medicare or do you want to not reduce funding for medicare? i'm flabbergasted. what do you want?
"...people with heart problems that are easy to treat in the U.S. (and cheap-relatively) die of those problems untreated in the NHS systems of Europe."
you sure? want to prove it? (everyone dies of those problems when untreated... if you can pull up some numbers on those dying untreated in NHS systems, maybe you'd care to pull up some numbers on those dying untreated here.)
20 - zingzing
my favorite rock star ever, and i consider that a very high honor indeed, one of the people i treasure the most in this life, because music is all, died of a heart attack a day after experiencing symptoms--because he did not go to the doctor or hospital because he lacked health insurance.
this man had a several top ten hits in the 60s, led one of the great bands of the early/mid 70s, was an absolute god in the late 70s/early 80s, and was thought of as an elder statesman of rock by many, but he never held a corporate job, never got a fair shake from the record business and never got paid his due.
he mowed his lawn one day, felt flush and weak, refused to go see a doc because it would cost too much, then died. his band was supposed to play a showcase dedicated to them two or three days later at sxsw. thing turned into a memorial.
if it can happen to ridiculously talented people, it can happen to you.
amen.
21 - Cannonshop
#19 Zing, I want medicare to WORK. I want it to be worth the money it gathers from the taxpayers, or worth MORE in terms of WORKING. I want it to be (at minimum) as efficient in dollar terms as the Red Cross. (where 90 cents of every dollar goes to delivering services, rather than administration fees). I have accepted that it will never go away, like nearly all government operations, it's going to be there forever whether it carries out its mission for real, or merely cosmetically, so I want it to actually do the job it was created (ostensibly) to do.
I also want the option NOT to rely on it if I choose not to. As a tax-payer, I can't opt out of paying for Medicare, and as a human being cursed with a conscience, I can't call for denying care to those who need it merely to satisfy my own pocket, but I CAN demand that, if I get sick, I am not forced into a state-run system where lives are merely statistics tracked against a bureaucratic budget by people with established bureaucratic 'kingdoms' and jealously protected state-funded perks.
It's my life, my responsibility, my right NOT to be stuck on the waiting list if I can afford to avoid it, my right to choose traditional or herbal or invisible-friend-in-the-sky treatment over a state funded 9-to-5 doctor who really has no reason to give a shit whethr or not his treatments work so long as he's checked the right boxes on the state-issued-treatment-form.
I don't want to be coerced, but I will be, and at this stage in my life, I just recognize that fact-but I demand my right NOT to coerce someone else into paying my bills for me, caring for me, etc. etc.
Which is where socialized health-care schemes and I part ways, because those systems inevitably demand that people like me be forced into relying on them, not merely paying for them, as unwilling partners in blackmailing and extorting others.
22 - Clavos
because he did not go to the doctor or hospital because he lacked health insurance.
Well, zing, if a multi millionaire (or possibly billionaire, like the Beatles?) doesn't have health insurance and doesn't go to the dr., it's his own fault if he dies.
Puleeze. Of all the guys I hung out with in college,the richest is a rock singer who only had a handful of top 40 hits in the 70s and then fizzled out. But they still play his songs on soft rock stations and he gets two royalties (singer and songwriter) and the money just keeps rolling in 24/7/365.
And he was only a minor star...
23 - Clavos
...I CAN demand that, if I get sick, I am not forced into a state-run system...
You may not know this, but you can't elect not to take Medicare once you're eligible because since it's there, the insurance companies will only insure you as secondaries. I know this because, when I became eligible for Medicare, I had a top of the line Bentley plan (It was better than a Cadillac plan), so I figured I'd stick with it, even though the premiums were $1000/month, but they dropped me, saying I was eligible for Medicare, so they were no longer my primary, Medicare was.
Now the liberals will say "see the private insurers screwed you over," but they did so because there was a government plan competing with them, so when Obama says O-Care won't eliminate the private insurers, he's talkin' through his ass. It will.
24 - zingzing
"Well, zing, if a multi millionaire (or possibly billionaire, like the Beatles?) doesn't have health insurance and doesn't go to the dr., it's his own fault if he dies."
he didn't have the money, clavos. he wasn't a millionaire by any means. he got fucked by the record industry, but he didn't really care. in the 60s, record contracts were nowhere near as bloated as they were in the 70s, and by the 70s, this guy was working for a series of failing record companies.
but he should have been rich. such were the terms of his licensing contract that one of his songs (rerecorded, unfortunately) was used on a syndicated tv show that lasted for 7 seasons or so on major tv stations, and he got something like $8 a day off it, he says.
it's hard to trust everything he said, but he died after mowing his own lawn, and i doubt that's something all that many 59-year-old multi-millionaires do.
25 - Clavos
Sorry, zing, I didn't read your first comment about him all the way through. My apologies to you and by extension (and posthumously), to your friend.