I have advocated here and elsewhere for the forced stillbirth of the Independent Payment Advisory Board, due to go into action later this year.
The IPAB is a Medicare cost-cutting board of “experts” legally possessed of the autocratic power to impose its “advice”–even over a presidential veto. It does not currently have health care rationing powers, but as I have noted, powerful voices have called for granting it such death panel status.
I have argued that the Republican Party should engage in “total noncooperation with IPAB.” For example, I urged that Speaker Boehner and Leader McConnell refuse to recommend names for the IPAB board because it doesn’t work to castigate the IPAB and then help find people to run it.
Such soft power has worked, and now even its most vocal supporters, like the New England Journal of Medicine, have noticed that IPAB seems stuck on the lunching pad. From a NEJM editorial, ”Failure to Launch?”
3 years after the ACA’s enactment, the IPAB still has no members. Secretary of Health and Human Services Kathleen Sebelius described “active discussions” about IPAB nominees in February 2012 and said last month that the administration was “consulting Congress regarding “potential members.” But President Obama has not yet nominated anyone for the IPAB, and Republican congressional leaders have refused to provide any recommendations for appointees.
Even if Democrats settle on nominees, the controversy surrounding the IPAB will make their Senate confirmations, which are subject to filibuster, extraordinarily difficult. Presidents historically have made appointments when the Senate is in recess, and President Obama conceivably could fill some IPAB slots in this manner. But recess appointments are temporary, lasting only until the end of the next congressional session.
The Obama Administration seems to understand the problem, hence its inaction on the IPAB front. After all, if the president nominates members for the IPAB board, the hearings will become a splendid public platform for educating the public about the wolf that this way comes wearing sheep’s clothes of improving access to health care. Obama never wants that. That was why he gave the health care rationer Donald Berwick a recess appointment, when the Democrats controlled the Senate overwhelmingly and had not even called a committee hearing where Berwick would have testified!
Conveniently, Medicare now says it won’t need IPAB’s services in 2014, allowing Obama to play for time by not appointing members now. But the NEJM editorialist laments that politics are ruining the launch of the technocracy:
Yet the difficulties in launching the IPAB point to a more fundamental problem. The board’s appeal lies largely in its aspiration to remove politics from Medicare–to create a policymaking process that is informed by experts and insulated from electoral pressures, interest-group demands, financial considerations, and partisan divisions. But given Congress’s extreme partisan and ideological polarization, the ongoing fight over the ACA, the legacy of mythic “death panels,” and recriminations over Medicare reform, the IPAB’s rough start should not be surprising. This is not the sort of political environment in which an independent board charged with making controversial decisions about one of America’s most popular social programs is likely to thrive. These dynamics are unlikely to recede soon, which means that the IPAB is stuck in purgatory, neither operational nor canceled–an institution designed to be above politics that cannot escape the political binds holding it back.
CLICK LIKE IF YOU’RE PRO-LIFE!
Purgatory will have to do until the thing can, like the Wicked Witch of the East, be made not merely dead, but really most sincerely dead.
LifeNews.com Note: Wesley J. Smith, J.D., is a special consultant to the Center for Bioethics and Culture and a bioethics attorney who blogs at Secondhand Smoke.