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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