Thursday, April 24, 2014

The Unaccountable Care Act**

The Other Stealthy ObamaCare  Menace: The Center for Medicare and Medicaid Innovation Exists to Impose Price Controls and Limit Payments To Providers

Title of OP-Ed article,  by Lanhee Chen and James Capretta,  Wall Street Journal, April 23, 2014

Another title for the health law, other than “The Patient Protection and Affordable  Care Act, “ might be “The Provider Rationing  and Unaccountable Care Act.”

As  Lanhee Chen of the Hoover Institution and James Capretta of the American Enterprise Institute observe:

“The Affordable Care Act’s Independent Payment Advisory Board  has been so heavily criticized for being an unaccountable body with the power to effectively ration Medicare services that many congressional Democrats no longer support it.”

It is unaccountable for good reason.   The Independent Advisory Board and its bureaucratic cousin, the Center for Medicare and Medicaid Innovation – never has to go back to Congress to get an appropriation.  ObamaCare  gave it $10 billion , upfront, to cover its first 10 years, and after that, it can get another $10 billion – no questions asked.  Meanwhile it will grow from its initial 68 employees to 440 full time workers by 2015.

And what has the Independent Advisory  Board (IPA) and the Center for Medicare and Medicaid Innovation  (CMMI) done to justify this lavish expenditure?

The IPA has done nothing.  Its so-called 15 “experts,” who were to be charged with the duty of limiting hospital and physician reimbursements, have yet to be appointed.

The CMMI has been busy promoting  Accountable Care Organizations (ACOs),  herding doctors into hospital-physician organizations to “save” Medicare and Medicaid money,   talking about “bundling” hospital-physician services,  and engaging in slashing  payments to Medicare Advantage plans, to which 30% of Medicare recipients belong.    

The IPA-CMMI agency’s mindset is that the federal government is best positioned to lead a medical innovation effort through demonstration projects.

At this effort,  it will surely fail.     As I pointed out in my book The Health Reform Maze: A Blueprint for Physician Practices (Greenbranch Publishing, 2010), government is poor at innovation.


·          It cannot manage failure.

·         It  seldom abandons a project.

·         It is not gambling with its own money.

·         Its success is measured with good intentions, not results.

·         It succeeds by growing too big to fail and too influential to stop.

·         It cannot go out of business, can print money to keep going, and is propped up by taxpayer money, and does not understand risk - the basis of American capitalism.”

To this list I would add,  government  is secretive,can hide behind its bureaucratic shield  and its media protectors. 

Innovation comes in many forms- electronic, organizational. communicative , and technological.  Lately, social networking through Twitter, Facebook, and  YouTube have gotten the greatest play. Government is not destined to win any innovation honors.   Paradoxically,  at least in the government’s eyes, only deregulation and  market-competition,  which  government elites abhor, not  bureaucratic micromanagement, will achieve what government says it wants to happen.

Tweet:  2 government agencies, Independent Payment Advisory Board and  Center of Medicare and Medicaid Innovation,  will fail to contain costs or to innovate.

**(If you wish to comment or need more information,  email me at, or call me at 1-860-395-1501.  I am available for writing columns or articles  and for speaking engagements.   I would be happy to publish your comments on my blog, which is currently getting 4000 to 6000 page views each day.)

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