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the subcommittee's action said that "In the end IPAB will decide who lives and who dies; that is why it must be repealed and receive full committee and House floor votes as soon as possible.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.
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