Friday, April 15, 2011

Health Reform and the Friday after Obama’s Speech

April 15, 2011 – It’s Friday – the Friday after President Obama’s speech questioning Republicans’ budget deficit plan , asking for more taxes on “the rich, ” rallying the forces of the left, and laying out his plan to reduce the federal deficit.

I spent this Friday morning reviewing the health care community’s reaction to the speech, which promised to cut $480 billion from the deficit, mostly by reducing “fraud and abuse.” and putting a ceiling on health care spending.

How will President Obama impose this ceiling? By creating a top-down non-partisan government agency , called the Independent Payment Advisory Board (IPAB), starting in 2018, which will set a ceiling of 0.5% plus GDP, then arbitrarily deciding whose payments shall be cut.

For those of you not in the know, The Independent Payment Advisory Board, or IPAB, is a United States Government agency created in 2010 by sections 3403 and 10320 of the Patient Protection and Affordable Care Act. The Board has the explicit task of reducing the rate of growth in Medicare and Medicaid without affecting coverage or quality.

Reaction came swiftly. The AMA, the AHA, and the American College of Cardiology, among others, announced opposition to the IPAB. The AHA asked for IPAB repeal, saying its actions would be “arbitrary.” The IPAB would be out of touch with reality with forces driving health costs – chronic disease, aging, new technologies, and increased prescription drug use.

The IPAB will be a board composed of 15 doctors, nurses, health care experts, and economists – all appointed by the President and acting “independently” of the Congress and the President.

Critics asserted if you believe in the IPA’s “independence,” I have a bridge to sell you. In the real world, “IPAB,” they say, is short for “ Intellectual Pabulum, “ meaning the new agency is long on politics and short of substance.

Perhaps most telling was this passage from an article by Jason Fodeman, of the Galen Institute, commenting on the health reform law which contains a provision establishing the IPAB.

“PPACA will strip away physician autonomy, drown doctors in bureaucracy, and drain job satisfaction. As the profession deteriorates, older doctors will retire while younger doctors will look to switch careers. Many students considering a careering in medicine will pursue other opportunities. The supply of providers will dwindle as demand for services reaches an all-time high. Ultimately, the consequences of health overhaul law will be passed along to patients through restricted access, long wait for appointments, and rationed care.”

This passage may be overstated, hyperbolic, and apocalyptic. Still, it harbors truths. The health reform law and its IPAB provision aimed at limiting physician pay may well precipitate an access crisis for patients and a crisis within the profession itself.

Tweet: The AMA, AHA, , and most physicians oppose the Independent Payment Advisory Board proposed by President Obama for not being “independent.”

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