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IPAB and the Nuclear Option

November 26, 2013
11:55 am

With U.S. Senate Democrats exercising the so-called ‘nuclear option’ – changing Senate rules so that executive branch nominations can be approved by a simple 51-vote majority instead of the 60 votes needed to overcome a filibuster – there has been speculation about what this means for the Independent Payment Advisory Board (IPAB).

IPAB, as health policy aficionados know, is the 15-member board of political appointees created by the Affordable Care Act that has unprecedented powers over Medicare spending.  To summarize IPAB in a nutshell, if Medicare spending exceeds an arbitrary level set by law, IPAB board members will offer recommendations on how to cut outlays.  If Congress doesn’t achieve a supermajority in favor of an alternative approach, or doesn’t act at all, the IPAB recommendations automatically take effect.

HLC and hundreds of other patient and healthcare provider groups oppose this concept for a number of reasons, including the likelihood it would result in arbitrary reimbursement cuts that would undermine healthcare quality, accessibility and value as well as the fact it gives an unelected, unaccountable board powers constitutionally assigned to elected members of Congress.

IPAB’s controversial nature meant that it would be extremely difficult for the White House to successfully appoint board members – that is, if the Senate still had a 60-vote threshold for confirmations.  Now that the ‘nuclear option’ has been invoked, some reports have said this is good news for an Administration that no longer needs Republican votes to fill the IPAB vacancies.

The fact is, though, that this is something of a non-issue.

As the Cato Institute’s Michael Cannon explained quite well in Forbes, the IPAB provisions in the Affordable Care Act make provisions for the eventuality that the President doesn’t nominate or the Senate doesn’t confirm board members.  If that occurs, all of the powers granted to IPAB automatically transfer to the Secretary of Health and Human Services.   If that happens, significant powers to control Medicare spending would have transferred from the legislative branch to the executive – definitely not what our Founding Fathers intended.

All this is to say that the only way to keep Medicare beneficiaries from being harmed by IPAB is to repeal it altogether, something both Democrats and Republicans in both houses have indicated they want to do.

Where The Savings Are

November 21, 2013
12:12 pm

There is more good news on the healthcare cost front.  The White House Council of Economic Advisers has issued a report noting that real per capita healthcare spending has increased in this decade at an average annual rate of just 1.3 percent.   This lower spending rate – which encompasses Medicare, Medicaid and private health insurance – represents the lowest healthcare price inflation rate in 50 years.

(Reasonable people will have differences on the reasons for this cost containment success.  The White House, understandably, wants to give ample credit to the Affordable Care Act.  Some say it’s a result of the nation’s economic stagnation.  I would argue that innovations in many healthcare sectors – documented in detail here – are providing patients and consumers with higher quality at less cost.)

This continuing trend regarding healthcare costs deserves special attention as a special joint congressional committee negotiates budgetary issues.  There is a desire among many lawmakers to do away with all or part of the budget sequester and replace it with targeted cuts.  The data we’re seeing from the White House and other sources underscores that there is no compelling reason to target healthcare programs for arbitrary reductions, cuts that could have an adverse impact on access, quality and innovation and undo many of the successes we’re seeing in containing long-term cost escalation.

Instead, if Congress is looking for some possible pools of money to replace sequester cuts, a good idea might be hiring the Pentagon some better accountants to see what the military is getting for trillions of dollars in spending that has, according to a Reuters investigation, never been sufficiently audited.  Just a thought.

Sympathy Shouldn’t Be Litigated

November 01, 2013
10:26 am

The Pennsylvania state legislature has passed a medical liability measure that doesn’t make malpractice lawsuits more or less difficult or affect the level of damages a plaintiff may receive, but it does take a meaningful step forward in support of compassion and basic humanity.

Pennsylvania lawmakers adopted what they call “benevolent gesture” legislation.  Essentially, it corrects one of the deplorable side effects of today’s medical liability environment.  The bill allows doctors to communicate to patients’ loved ones as human beings.

The fact is, even if a physician does everything right and according to evidence-based protocols, unfortunate outcomes happen.  But, in today’s environment, doctors are unable to express sympathy or concern to patients’ families for fear that those words can be used against them in a courtroom.  Simply saying ‘I’m sorry’ for a family’s loss can be misinterpreted as an admission of malpractice.

Thus, patients’ loved ones find themselves angry at doctors who they view as uncaring, simply because of this invisible wall between them that is created by possible litigation.

The Pennsylvania law simply states that healthcare providers can express words of condolence, compassion or commiseration without those sympathetic thoughts being considered admissible evidence in any future legal actions.  Without constraining in any way the right to sue, this legislation at least allows physicians and patients’ loved ones to act like people instead of potential courtroom combatants.