On Wednesday, a House of Representatives Energy and Commerce
subcommittee voted to approve, and send to the full committee,
H.R.
452, the Medicare Decisions Accountability Act of 2011,
which “repeal[s] the provisions of the Patient Protection
and Affordable Care Act providing for the Independent Payment
Advisory Board.”
In short, 15 Republicans and two Democrats voted to stop
the implementation of the Obamacare bureaucracy that Sarah Palin
famously termed “death panels.” The Independent Payment Advisory
Board (IPAB) would recommend reductions in Medicare payments needed
to keep the system within budgetary restrictions. Conservatives
such as House Budget Committee Chairman Paul Ryan say it represents
nothing less than health care
rationing while Obamacare supporters say
that IPAB offers needed cost controls and that Congress can
override IPAB recommendations or suggest other cuts to keep
Medicare solvent. They are both right.
Prior to the vote, the Obama propaganda machine
argued in favor of IPAB, claiming (to nobody’s surprise) that
Republicans want to “shift costs to seniors and empower insurance
companies.” The next ad of Paul Ryan pushing wheel chair–bound
Granny off the cliff can’t be far behind. (Isn’t it preferable for
reasons both economic and ethical to “shift costs” to those
actually using the medical care rather than to their grandchildren?
Isn’t what we’re doing now the true cost-shifting? And isn’t it
wiser to “empower insurance companies” who have to compete for
business rather than empowering the already power-mad Kathleen
Sebelius and her officious successors?)
Conservative and free-market organizations are cheering
Wednesday’s vote. On Tuesday, the National Right to
Life Committee “called
for quick approval” of the IPAB repeal. Americans for Limited
Government President Bill Wilson’s press
release following the subcommittee’s action
said that “In the end IPAB will decide who lives and who
dies; that is why it must be repealed and receive full committee
and House floor votes as soon as possible. This provision always
has been an abomination.”
The idea of unaccountable government bureaucrats deciding
whether your family member should get needed medicine, or whether
in their wisdom it’s just not worth it, is truly frightening. The
implications for our liberty — and for our very lives — are far
beyond any power that our Founding Fathers could have imagined
being placed in the hands of the federal government.
But is the political right making a mistake by voting to
repeal IPAB? Are Democrats’ crocodile tears masking secret smiles,
with their plaintive “please don’t kill the death panels” (if
perhaps not in exactly those words), the political equivalent of
Br’er Rabbit’s pleas not to be thrown into the
briar patch?
By removing one of the most objectionable provisions of
Obamacare, one of the most effective “bumper sticker” arguments
against it — especially among the critical voting group of senior
citizens — opponents of the Democrats’ de facto takeover of our
nation’s health insurance industry leave a marginally less
detestable law than we have now.
President Obama and Congressional Democrats could hardly
ask for a better election year gift.
A wise friend who serves in the Colorado State Senate says
that he doesn’t believe in “trying to make bad bills better”
because the usual impact is to ensure that only slightly less bad
bills become or remain law.
But this is just what H.R. 452 does. Making Obamacare
“better” will boost Democrats’ arguments that the law can and
should be “fixed” or “modified” or “tweaked” rather than repealed,
a position which benefits their electoral prospects by cooling
voters’ simmering hatred of Obamacare — while cementing in place
one of the most egregious power grabs in American
history.
Obamacare is a cancer on our economy and our political
future. When a cancer is diagnosed, a doctor goes to every effort
to remove all of it, recognizing that removing only the
currently visible or painful part means just a slightly slower
progression toward death. If a doctor treated cancer the way
Republicans are treating Obamacare, by working to eliminate just
the most visible portion and suggesting that the body (politic)
will then be healthier, he would rightly be sued for
malpractice.
The problem with IPAB is not that bureaucrats will be
making Medicare spending recommendations. It is that such an
organization is an inevitable, even sensible, outcome of
government-run medicine. After all, what is the alternative to cost
containment, especially in the context of a population that through
demographics and legislation is increasingly dependent on
government for provision of health care? After all, nothing is as
expensive as something everyone thinks they’re getting for
free.
If IPAB is eliminated, where will cost control come from?
Voters will stand neither for bankrupting our children nor for any
reduction of benefits — but if they have to accept one, it will be
the former. Knowing this, members of Congress are more afraid of
short-term electoral punishment if they try to curtail the cost of
Medicare than they are of immorally loading future generations with
ever more massive debt.
Republicans have been less than uniformly helpful on this
score, with former Massachusetts Governor Mitt Romney’s rhetoric
being Exhibit A. During the Arizona Republican Presidential
Debate
last week, when explaining why he wants to repeal Obamacare, Romney
said, “I don’t believe the federal government should cut Medicare
by some $500 billion.” It’s not the first time he’s offered this
reasoning.
Obamacare used $500 billion of theoretical cuts to
Medicare Advantage, which the president and his supporters have
zero intention of allowing to come to pass, to claim that the total
cost of the bill would be less than $1 trillion in its first
decade. (The Advantage program, while not without its flaws and
critics, is one of the only places where Medicare allows
competition and the use of private insurance to supplement
Medicare. It is thus no surprise that this is the part of the
entitlement system that Democrats chose to gut.)
In contrast to Romney’s pandering, Rick Santorum said that
if he becomes president, he “will deal with Medicare and Social
Security, not 10 years from now. But we need to start dealing with
it now because our country is facing fiscal bankruptcy.”
Santorum’s answer was honest, and the only moral and
constitutional position to take. But Romney’s view is,
unfortunately, accurately calculated to be a political winner. And
Romney is not alone. Recently retired Congresswoman Ginny
Brown-Waite (R-FL) made arguments similar
to Romney’s in 2009, suggesting that tort reform and curtailing
“waste, fraud and abuse” — always Republican magic bullets — are
the primary cost savings worth considering, adding that “any
savings in Medicare have to go back into the Medicare system”
because of the number of people moving into the system.
If Republicans, supposedly interested in economic sanity
and limited government, argue against cutting the cost of Medicare
— which makes up the largest portion of our nation’s more than $60
trillion in unfunded entitlement mandates — what hope is there of
preventing it from destroying the national fisc?
As abhorrent as the vision of IPAB “death panels” is, what
choice does our nation have if government is the primary provider
of health care funding? Medicare’s finances are
speeding toward an immovable brick wall of economic reality.
Obamacare stepped on the gas. Congress has demonstrated through
years of “doc fix” legislation that it does not have the stomach to
step on the brakes, or even to get behind the steering wheel. This
leaves IPAB as perhaps the only realistic way to slow us down,
making the inevitable crash something we might, if we’re lucky,
survive even if economically bruised and bloodied.
Repealing IPAB, as Republicans seem intent on trying to
do, is both an economic and political mistake.
Economically, it removes the only viable tool currently in place to
keep Medicare costs under control. Politically, it weakens voter
support for the repeal of Obamacare in its entirety (a critical
first step toward broader entitlement reform). Yes, those two
arguments may sound contradictory, but such is the nature of
entitlement politics in America.
The best thing that could happen to Republicans and the
nation is for the Senate to refuse to pass H.R. 452. Repealing
IPAB, like excising just a fraction of a metastasizing cancer, is
political and economic malpractice.
