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75% of Americans believe that the ObamaCare individual mandate which requires everyone to buy health insurance is unconstitutional. However, there are equally unconstitutional provisions in the ObamaCare law that are garnering less attention. Perhaps the most dangerous of the lot is the Independent Payment Advisory Board, or IPAB.
Despite the furor over “death panels” while ObamaCare was being debated, congressional Democrats still managed to sneak IPAB into the 2,801 page bill. Very simply, the mission of IPAB is to reduce Medicare costs by cutting reimbursement rates to doctors and hospitals. Since Medicare already underpays the health care industry, another round of deep cuts to reimbursement payments will doubtlessly push even more physicians and hospitals to stop accepting Medicare recipients. For rural recipients of Medicare with limited access to health care providers as it is, these cuts could make it difficult if not impossible to get health care. This is rationing in its most basic form.
The board itself will consist of fifteen purported health care “experts” appointed by the president. In effect, this means that a handful of unelected bureaucrats will be making critical decisions regarding the health care of the tens of millions of Americans who receive Medicare benefits each year. Although the Secretary of Health and Human Services has claimed that the decisions made by IPAB are merely recommendations, this is true only in the most technical sense.
These “recommendations” carry the force of law unless two-thirds of Congress overrules them. Considering the gridlock in Congress, this is a pipe dream. Alternatively, Congress can pass legislation that cuts as much as IPAB, but isn’t this a case of the tail wagging the dog? Why should our elected representatives take marching orders from a few unelected bureaucrats?
It’s obvious that we must find a way to rein in health care costs. After all, Medicare will undoubtedly bankrupt America given the skyrocketing cost of health care. However, the meat-ax approach of IPAB is the wrong solution to the problem. We need fundamental health care reform that follows basic economic principles to drive down costs, such as through increasing the supply of health care. Cutting reimbursement rates to doctors and hospitals may cut costs in the short-run, but in the long-run it will severely reduce the supply of health care and only worsen the problem of rising costs.
IPAB isn’t just bad policy. More importantly, it’s also unquestionably unconstitutional. Columnist George Will describes IPAB as, “an executive agency, its members appointed by the president, exercising legislative powers over which neither Congress nor the judiciary can exercise proper control.” Does that sound like a program that follows the constitutional principle of the separation of powers? No executive agency should be allowed to exercise legislative authority. Yet, that’s exactly what IPAB does.
Congress is trying to pass the buck on difficult decisions regarding Medicare costs by delegating away the lawmaking power. This way, they can take credit for health care reform and spending cuts while shifting away blame for the specific cuts put in place by IPAB. It’s spineless and damaging to constitutional government. Worse yet, the ObamaCare law expressly forbids the courts from striking down IPAB. As George Will suggested, IPAB is a part of the executive branch that wields the legislative power without congressional or judicial oversight.
In effect, this means that IPAB will be the only judge of the law that it creates and executes. Such an accumulation of powers would be reprehensible to the Founders. As James Madison argues in The Federalist Papers, “The accumulation of all powers, legislative, executive, and judiciary, in the same hands… may justly be pronounced the very definition of tyranny.”
So, IPAB is unconstitutional, tyrannical, and bad policy. How do we stop it?
Right now, a bill is working its way through Congress to repeal IPAB. Representative Phil Roe (R-TN) has presented H.R. 452, or the “Medicare Decisions Accountability Act of 2011.” The bill has 234 co-sponsors and the House is expected to pass it, although it might face a tougher test in the Senate. Even the long-time progressive Barney Frank (D-MA) has signed on as a co-sponsor!
IPAB must be repealed, but doing so will gut the cost-cutting measures in ObamaCare and make a staggeringly expensive bill even costlier. The solution is obvious: Repeal and replace ObamaCare with market-based health care reform aimed at driving down costs and created a patient-centered system, instead of the top-down, bureaucratic approach preferred by the Obama administration.
TAKE ACTION: Tell Your Congressman to Vote YES on H.R. 452 to Repeal the IPAB Health Care Rationing Board.