AMA, GOP trying to kill new Medicare payment board


My wife recently surrendered to the relentless suggestions of her customers and purchased an iPad. She convinced herself it would be an indispensable tool for showcasing patterns and ringing up sales in the yarn store we've nursed and cajoled through the last seven years.

The first time we synced it with my computer, all the applications downloaded since its purchase disappeared. I was able to restore them, but the accompanying data was left to sleep with the fishes.

A similar disappearing act is occurring in healthcare right now involving the Independent Payment Advisory Board. It's a creation of the Patient Protection and Affordable Care Act. Unfortunately, though, this is no software glitch.

As the Washington Post reported last week, GOP movers and shakers and healthcare lobbyists are trying to dismantle IPAB. They claim that the 15 healthcare experts who would be appointed by the President, and permitted to make nearly unilateral decisions about trims to the Medicare program if it overspends, would be accorded too much power.

There are two things going on here: The American Medical Association has been one of the hardest pushers for the repeal of IPAB. This is primarily due to the untrammeled success AMA has had in getting Congress to ignore the recommendations of the Medicare Payment Advisory Commission, whose decisions are not binding. Overruling IPAB decisions would require a two-thirds majority vote by the Senate, which would be nearly impossible. That means every time IPAB recommended a cut, the AMA's membership would actually have to practice medicine more efficiently rather than resorting to the gimmicks I've long documented in this space.

The other is the smoldering anger among conservatives that healthcare reform exists. Given that the GOP-controlled House recently voted to move Medicare onto Groupon, you'd think they'd welcome IPAB with open arms; you'd be dead wrong, of course. Instead, killing IPAB is part of reform's slow starvation strategy adopted by the GOP the instant the ACA became law.

Unfortunately, the Democrats are--great shock!--wavering on defending IPAB. Its demise would mean a large chunk of the projected savings from reform could wind up vaporizing.

My old friend Mark Finucane, who ran the Los Angeles County healthcare system a decade ago and is now at professional services firm Alvarez & Marsal, summed it up pretty succinctly during a phone chat last week.

Finucane had just returned from Oklahoma. To his surprise, the Sooner State actually has a fairly sophisticated Medicaid program, he told me. But the Legislature just turned down more than $50 million to build its insurance exchange, solely due to its "Obamacare" taint. Kansas just rejected its $31.5 million in funding, as well.

"They can unravel reform, but the problems won't go away," Finucane said.

My wife has reloaded all those lost shawl patterns. My daughter also is busy cooking up batches of new e-mooncakes for the virtual Asian restaurant whose data was disappeared. "Soon we'll be able to afford a new chef," she cheerily exclaimed one recent morning. Unfortunately, there are way too many non-virtual "chefs" lurking around healthcare reform, trying to drown it in a broth of politics.

Restoring a three-week-old iPad is a cinch. But if IPAB is taken offline permanently, there will be no easy fix for any of us. - Ron

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