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Howard Dean: “The IPAB is essentially a health-care rationing body”

Howard Dean: “The IPAB is essentially a health-care rationing body”

Howard Dean wrote in the Wall Street Journal that ObamaCare’s IPAB needs to be “removed.”  He explains why in terms that will be familiar to those of us who have opposed the ObamaCare Tax nightmare from the beginning:

One major problem is the so-called Independent Payment Advisory Board. The IPAB is essentially a health-care rationing body. By setting doctor reimbursement rates for Medicare and determining which procedures and drugs will be covered and at what price, the IPAB will be able to stop certain treatments its members do not favor by simply setting rates to levels where no doctor or hospital will perform them.

There does have to be control of costs in our health-care system. However, rate setting—the essential mechanism of the IPAB—has a 40-year track record of failure. What ends up happening in these schemes (which many states including my home state of Vermont have implemented with virtually no long-term effect on costs) is that patients and physicians get aggravated because bureaucrats in either the private or public sector are making medical decisions without knowing the patients. Most important, once again, these kinds of schemes do not control costs. The medical system simply becomes more bureaucratic.

The nonpartisan Congressional Budget Office has indicated that the IPAB, in its current form, won’t save a single dime before 2021. As everyone in Washington knows, but less frequently admits, CBO projections of any kind—past five years or so—are really just speculation. I believe the IPAB will never control costs based on the long record of previous attempts in many of the states, including my own state of Vermont.

If Medicare is to have a secure future, we have to move away from fee-for-service medicine, which is all about incentives to spend more, and has no incentives in the system to keep patients healthy. The IPAB has no possibility of helping to solve this major problem and will almost certainly make the system more bureaucratic and therefore drive up administrative costs.

To date, 22 Democrats have joined Republicans in the House and Senate in support of legislation to do away with the IPAB. Yet because of the extraordinary partisanship on Capitol Hill and Republican threats to defund the law through the appropriations process, it is unlikely that any change in the Affordable Care Act will take place soon.

The IPAB will cause frustration to providers and patients alike, and it will fail to control costs. When, and if, the atmosphere on Capitol Hill improves and leadership becomes interested again in addressing real problems instead of posturing, getting rid of the IPAB is something Democrats and Republicans ought to agree on.

The IPAB is “essentially a health-care rationing body”?  You don’t say!  Back when Sarah Palin was warning about health-care rationing and death panels (what the IPAB essentially is because that’s what health-care rationing essentially is), Dean said such accusations were “made up” because, apparently, you can’t have a death panel without reference to “euthanasia” or something “like” it.  Now, suddenly, you can have health-care rationing without direct reference to rationing.  Or something.

He’s arguing that rate-setting itself is doomed to failure, and that’s quite an admission from a big bigger biggest government pol like Dean, though I don’t think we can expect him to admit that the same principle he outlines here actually applies in other areas, as well.  He’s certainly not suddenly becoming an advocate for the free market.

But he’s finally got it right: the IPAB is essentially a health-care rationing body, and we should all be able to agree that there is nothing good — no improved health care, no decreased costs — that can come of it.


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For once, Howard Dean is making sense. Maybe that’s because at last he’s speaking from the point of view of a physician genuinely interested in helping patients.

I have to wonder where his head was at when Obamacare was passed.

    Not A Member of Any Organized Political in reply to fmc. | July 30, 2013 at 11:26 am


    Howard Dean – BIG DEMOCRAT

    raven in reply to fmc. | July 30, 2013 at 12:34 pm

    This isn’t about making sense or seeing the light. This is about Leftism, in its intentional stratagems and deceits and how brilliantly Leftists exploit failure, turn crisis into opportunity. Obscuring and spinning the truth of the death panels at the outset was necessary and intentional. Now, the argument against death panels — and the feigned mea culpas and vows to rectify — is a preemptive attempt to force the republicans into a partial fix which in fact concedes the institutional reality of Obamacare — as opposed to an effort to defund or repeal the entire thing. If Republicans don’t agree, they’re left holding the bag on death panels. The goal is to fob off the horror of the death panels on Republicans, just as they are trying to fob off the horror and failure of Detroit on them.

      Rick in reply to raven. | July 30, 2013 at 12:48 pm

      That is an excellent analysis and articulation.

      deadrody in reply to raven. | July 30, 2013 at 1:03 pm

      Plus, the liberal’s answer will always be, “the only way to truly fix it is to have gov’t run single payer health care”

      You don’t think they made Obamacare this much of a disaster solely by accident did you ?

    rocketmax in reply to fmc. | July 30, 2013 at 3:00 pm

    It was up his butt – where it usually is !

    ThomasD in reply to fmc. | July 30, 2013 at 6:26 pm

    Back before Obamacare was rammed through Congress Howard Dean had a chance to speak out against the IPAB.

    Howard Dean made a calculated decision to bite his tongue, and only now is he speaking out.

    My only suggestion to Dean is not fit for print.

Carol Herman | July 30, 2013 at 11:21 am

I remember back in the days the neighborhood doctor made house calls (for $10). He had a nurse (who may have also been his wife.) And, the medicine he practiced was called “general practice.” Specialists were not the general rule. And, if you could afford it you went to doctors whose offices were on Park Avenue.

Things changed. What got added (around the 1970’s) was insurance. So a patient came in for an office visit ($15). And, handed you an insurance form to fill out. You couldn’t put down “routine visit” because then the insurance company wouldn’t pay for it. (So you wrote down “yeast infection.” For the patient to be reimbursed.)

Medicine’s changed since then. Medical students put in 3 year residencies, instead of one year internships. And, they “specialized.” The specialty programs picked their best candidates. But still, a man could open his own office. For about $60,000.

But along came the lawyers. And, the high fees paid by doctors to be insured. And, this whole thing grew like topsy. A doctor needed more than just a receptionist. He needed to staff both front and back offices. He usually needed to go into practice with others, so he could get a few nights off from “call” during the week.

Today? About 20 people are being paid from the proceeds earned in any medical office. The old “hands on” way (where your doctor knew you, your condition, and your family matters), has also gone the way of the wind.

What medicine has become to the Federal government is a JOB BASE where uneducated fools can be hired. Especially since manufacturing jobs went overseas to “elsewhere.”

We got the “same” gift with TSA. Oh, yeah. Because buildings fell down when we were attacked on 9/11, the bureaucracy’s solution has been to create thousands and thousands of useless jobs … where, if you choose to fly … you’re given rules that include “no shampoo bottles” can be carried onto planes. Take your shoes off. Take your belts off (even if your pants fall around your ankles.)

Oh, and the best. Think of these solutions as absolutely grand. It’s a jobs finder like nobody’s business.

The good news? If you choose not to fly, but to drive, your car will be equipped with GPS, not for you. But for the government to collect data.

And? If you waved a magic wand … and all this harassment would disappear … what would you do with the army of unemployed you just created?

    I nostalgically remember driving around as a youngster relishing in the thought that I, as an American, could travel anywhere in our huge country with complete anonymity. I even taught that to my children as a magnificent, but taken for granted, difference between America and most other countries. Now we know that President Reagan was right: We will tell our grandkids about what it was like living in a free country. I do that now, regularly. Their next installment is in about an hour when I head out to the rifle range with my granddaughters.

      Phillep Harding in reply to Rick. | July 30, 2013 at 9:39 pm

      Your grandchildren will be “encouraged” to inform on you for sedation if you try telling them about what it was like to live in a free country.

Taking a cue from the IRS this panel will “allow” no treatment for conservatives.

Will Dean win Politifact’s Lie of the Year award the way Sarah Palin did back in 2009?

(That’s a rhetorical question, son.)

Humphreys Executor | July 30, 2013 at 11:54 am

So under the system Dean advocates, will society pay indefinitely for dialysis for a 90-year-old patient with advanced Alzheimer’s just because the family wants it? There’s going to be rationing one way or another.

Wasn’t that the plan all along? Force the insurance purchase, collect the money and deny the care! Costs stay low, the sick die and the gov gets more money for “investing” money in themselves. There, national health care, designed like the original social security, die before you get any of it.

Real medicine, that made an actual difference in promoting longevity and curing or controlling chronic diseases, is relatively new, with the exception of trauma medicine and sanitation, particularly in child birth. When I was a kid, there was 1 vaccine, 2 modestly effective antibiotics, topical antibiotics, a primitive insulin, digitalis and nitro, aspirin, opiates, and baking soda. There wasn’t all that much that could be done for anyone except support the patient and give him time to recover. This was the case no matter what your status or how much money you had. There was no holocaust.
The REAL advances in health were as much a consequence of childhood VACCINES, potable water, adequate nutrition, lead abatement, occupational safety, as well as car, infant protection, and highway safety……………Starting in the late sixties, real advances came on line, blood pressure medicines, oral treatments for diabetes, pace makers and open heart surgeries, chemotherapies and the early detection technologies (remember when any hope for cancer treatment was utterly reliant on early detection).. I could go on but you get the drift.
All that said, I am leery of the well funded squeaky wheels, activists, and special interest (re: medical device makers, pharmaceutical lobbies) determining “best medical practices” to the detriment of the rest of us; politicians for sale to the highest bidder, making medical policy. Does anyone doubt that its effect will be to preserve the status quo? Example: Can you imagine if the antivaccine folks had their way, how many children would be vulnerable to preventable diseases? I was BTW initially sympathetic to the mercury-vaccine hypothesis and I understood the power of its appeal to many desperate people, but really to throw the baby out with the bathwater?
Never fear, if it’s anything like Chicago, you should be able to bribe your way to the head of the line or get the “advanced treatments”.

Midwest Rhino | July 30, 2013 at 12:30 pm

A home care nurse does a home visit and the company gets about $140, even for 15 minutes of basic evaluation. But she doesn’t get half that. Same with a CNA, payout is like $82 for an hour, one of them I spoke to only got like $15, some get a little more, but the company/bureaucrats are pocketing a lot, and quality suffers.

And rates should be lower for downstate than big city probably, but they seem to base pay on “prevailing wage”, which is usually double the local wage.

But the customer/patient is usually on Medicare/Medicaid and doesn’t care about the cost, while hospitals and device providers seem to have gotten everything they wanted. Lots of Medicaid and illegal alien types showing up get expensive psych care or hip replacements and are a hospital’s best customers. So the 80% that have insurance have rates skyrocket to fund premium care to everyone the hospital can drag through their doors. Socialized medicine funded by a middle class “tax” explosion.

One doctor told me many don’t want to deal with all the hassles of their own practice. It has become much too complex, so they end up with a hospital or medical group usually, that sucks much of their profit. And the hospitals know how to suck every Medicare charge on the list, and cut their own ,costs by hiring their own hospital doctors that in my experience were young/foreign/inexperienced, and not too competent.

Again, centralizing power is nice for bureaucrats in DC and big hospitals, but incentive for quality doctors is diminished. Obamadon’tcare.

    ThomasD in reply to Midwest Rhino. | July 30, 2013 at 6:31 pm

    $15 an hour for a CNA? That’s darned good in my area. Around here ( KY/VA/TN Appalachia) some LPNs don’t make $15 and hour.

Indeed. And taken to its logical conclusion, assuming you are facing a life and death condition where the IPAB position would be the ultimate arbiter of what procedures you could or could not get…

You might call them, I don’t know, maybe DEATH PANELS

But whatever. That Palin, what a right wing NUTJOB she is. /sarcasm

JackRussellTerrierist | July 30, 2013 at 1:24 pm

The title of this post should have been “Howard Dean Has A Rational Moment”.

To date, 22 Democrats have joined Republicans in the House and Senate in support of legislation to do away with the IPAB. Yet because of the extraordinary partisanship on Capitol Hill and Republican threats to defund the law through the appropriations process, it is unlikely that any change in the Affordable Care Act will take place soon.

Translation: ObamaCare’s IPAB, passed into law over Republican objections, has major flaws that were glossed over at the time it was passed. And its the Republicans’ fault that nothing is being done about it.

Sorry, Screamin’ Howard. You broke it, now you own it.

Robert Reich went even further in 2009:

“We’re going to have to, if you’re very old, we’re not going to give you all that technology and all those drugs for the last couple of years of your life to keep you maybe going for another couple of months. It’s too expensive…so we’re going to let you die.”

My dad was one of he old fashioned physicians who made house calls, and patients actually paid with a meal, or a chicken. He rose to be head of a hospital, and when he died at age 46, 10,000 people came to give respects. This idea of death boards is already here. Remember the case of the little child who needed a heart, and the head of Obama;s health care said, “some must live, some must die?? The chld got her heart, after a public outrage, but what about all those who need treatment and are not cute little children? The old better get parachutes, as they are about to be pushed over the cliff in their wheelchairs.