Perhaps the most underreported and, until recently, least discussed aspect of the Affordable Care Act is IPAB, the Independent Payment Advisory Board. This 15-person unelected panel has yet to be selected; however, it will be a key to the success of Obamacare.
Health and Human Services Secretary Kathleen Sebelius has been quoted as saying that the majority of IPAB members must not be medical practitioners. Though some doctors may be represented, it is unlikely that they will be actively practicing clinicians who care for patients directly. Instead, the board will be populated by economists and other bureaucrats - "bean counters" - who will be given the responsibility of deciding how doctors caring for Medicare patients will get paid. It is anticipated that IPAB will drive payments so low that many doctors will be unable to offer certain services to patients, resulting in rationing of health care, which the administration fervently denies. Equally disturbing is IPAB's unaccountability to Congress, but President Obama is unfazed and actually thinks its oversight regarding health care does not go far enough.
IPAB is the Trojan horse of Obamacare. Like a Trojan horse or a worm invading your computer, IPAB will infect and corrupt the entire system once it has been embedded as part of the health care bureaucracy. IPAB has almost limitless power over Medicare spending. Written into the Affordable Care Act are provisions that essentially make its decisions exempt from congressional oversight and impervious to administrative or judicial review. It is a nearly autonomous agency operating as an arm of the executive branch. Conveniently, this does not occur until after the 2012 elections.
As if this weren't pernicious enough, President Obama thinks IPAB should have even more power - that of "automatic sequester," which means it would be able to prevent Congress from appropriating any additional money for Medicare outside of its purview. The president's handpicked deficit commission recommended that IPAB have a much wider range of power, including extending its authority to all of health care. This eventually would result in a single-payer, federally controlled health care system - a goal Mr. Obama has been working toward since at least 2007.
The bureaucratic framework is being constructed rapidly by the Department of Health and Human Services and will be reality unless the electorate wakes up and understands what is at stake in 2012. On our current trajectory, a European-style, socialized health care system is all but guaranteed. The GOP must do a better job of articulating this message effectively. Even Democrats in Congress recognize the danger that IPAB and Obamacare have created and are trying to distance themselves from it. It is a blatant, unconstitutional power grab that restricts the power of future Congresses. Rep. David P. Roe, Tennessee Republican, has introduced a bipartisan bill with more than 120 co-sponsors from both sides of the aisle, calling for the abolition of IPAB. A group of 272 medical organizations jointly signed a letter addressed to Congress urging IPAB repeal. Even the American Medical Association - one of the biggest supporters of Obamacare - says IPAB is an overreach and has called for its repeal.
It is time for doctors to wake up to the gravity of this threat and to understand that they have considerable influence and can reach millions of patients (voters) daily. They may be the last line of defense against what may prove to be the undoing of not just American health care, but our Constitution.
Dr. Hal Scherz is founder and president of Docs4PatientCare.
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