Pulling the Plug on Granny, Part 2

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(This post was update at 6:35 p.m.)

Yes, we’re back here again already, with at least one Republican claiming this week that Democratic health reform will kill seniors. Sigh.

The target of the GOP attack is the Independent Payment Advisory Board, a controversial group to be appointed by the president and charged with slowing the growth of Medicare spending, likely by cutting reimbursement rates to providers. IPAB, which will begin its work in 2014, was created by the Affordable Care Act and has consistently drawn criticism for shifting power away from Congress and to the executive branch. (Congress currently oversees Medicare payment rates, and therefore spending.) Republicans also say the board will inevitably end up “rationing” care for Medicare beneficiaries.

As if daring Republicans to take their attacks further, in April President Obama proposed strengthening the board, allowing its recommendations to kick in sooner. I wrote at the time that Obama was asking for a fight and would likely get one. Well, it’s here.

On Wednesday, reports Politico, Rep. Phil Gingrey, Republican of Georgia, said:

Under this IPAB we described that the Democrats put in Obamacare, where a bunch of bureaucrats decide whether you get care, such as continuing on dialysis or cancer chemotherapy, I guarantee you when you withdraw that the patient is going to die.

This is hyperbole at its worst. For starters, IPAB bureaucrats are not the final word on Medicare payments. Congress can overrule their recommendations, and IPAB board members must be approved by the Senate; they are not unilaterally installed by the President. In addition, the government already decides what procedures Medicare covers. The political fallout of an IPAB recommendation that yanks reimbursement for proven life-saving treatments like dialysis or chemotherapy would likely be so immense as to prevent this from happening. Far more likely are small reductions in reimbursements, concentrated in procedures and treatments whose health benefits have not been proven conclusively.

It’s not hard to figure out why Gingrey resorted to hyperbole. Republicans have been under fire ever since House Budget Chairman Paul Ryan introduced a plan, which Republicans in Congress voted for, to turn Medicare into a private health-insurance system in which seniors would end up paying far more of their health care costs out of pocket. The plan would “end Medicare as we know it,” Democrats and commentators have said, harsh words on an issue known to determine elections. (In fairness, there’s been plenty of hyperbole from liberals too, like this ad from a left-leaning non-profit that features an old woman careening off a cliff thanks to Paul Ryan.)

So it’s no surprise that some Republicans are trying to shift the conversation back to the dangers of Obamacare. Still, it’s sad to see the political conversation return to the fear-mongering and dishonesty that marked much of the health-reform debate. If you don’t think Gingrey’s contention that health reform aims to cause the deaths of seniors is dishonest fear mongering, check out what Don Taylor at the Incidental Economist blog revealed today: Paul Ryan himself proposed something similar to the IPAB in 2009.

(UPDATE: A spokesman for Ryan e-mails to protest my characterization of the congressman’s plan as “similar” to the IPAB. Ryan’s 2009 bill called for a 15-member board, coincidentally the same size board as the IPAB, to establish standards for care and ensure medical providers adhered to them. The point, according to Ryan’s spokesman: “encouraging transparency and proper metrics with respect to health care services, which will allow consumers to compare on the basis of cost and quality.” The IPAB will similarly base its recommendations on metrics and effectiveness, but would also make recommendations about Medicare reimbursement levels. Ryan’s bill would have given his 15-member board “no authority to influence Medicare spending,” according to the spokesman. This is a critical distinction.)

The IPAB, while favored by many economists as one of the only surefire ways to curb health-care spending growth, is a point of contention outside GOP circles. By and large, doctors don’t like it. They plausibly argue that cutting reimbursement rates could cause doctors to reconsider or stop caring for Medicare patients altogether.

At the heart of the matter, there are real philosophical differences between Republicans and Democrats over how to rein in health-care spending. The former holds that the free market and consumer choice will lower prices. The latter believes in a top-down, government-centric approach. But whenever either side introduces a caricature of a feeble, helpless senior citizen dying because of politics, the conversation that should take place stops, which is a shame.

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