One Fact of ObamaCare All Seniors Need to Know
The Medicare program is very important to American seniors and provides the primary resource that our aging population relies upon for their medical care. However, its existence and mission to provide health coverage being threatened by the rapid increasing rise in health care cost and our country’s rising elderly population. There are approximately 47 million people on Medicare today and projections are that number will increase to 77 million by 2030. The adoption of some type of health care reform is necessary to assure the program’s solvency. The recent law titled the “Patient Protection and Affordable Care Act” or commonly referred to as “Obamacare” claims to have done so. However, most Americans disagree. According to the most recent Rasmussen polls, most people favor repeal of the new health care law. The law, which was originally passed over a year ago, is over 2,000 pages and still growing. At the very least, this important piece of legislation is a challenge to read let alone understand. There is one change in the way Medicare will work, written in this law, which is critical to understand and may explain why the polls are just.
As part of the newly enacted healthcare law known as the “Patient Protection and Affordable Care Act,” commonly referred to as “Obamacare,” exist an entity was created named the “Independent Payment Advisory Board” or IPAB for short. This board consist of 15 members, all appointed by the President, who are responsible for making recommendations for savings in the Medicare program. We all know that Medicare, similarly to many other government programs, is burdened with waste, fraud, and abuse. I think everyone would agree that finding savings in the program to allow its future existence is a worthwhile goal. However, as you will soon learn, the healthcare law enacted and in still in its infancy of implementation, approaches this goal with a solution that will inevitably harm our seniors.
The IPAB board of 15 members will consist of experts in fields of economics, health finance, accounting, actuarial science, healthcare management, and at least one physician. However, the appointed physician would not be a practicing physician. This is clear requirement in the law which prohibits the physician from the practice of medicine while serving as a member of the board. This non-elected board will be making “recommendations” after finding “cost savings” in what medical procedures, medications, and spending priorities will be availed to Medicare patients. At first glance, you may think, that doesn’t sound all that bad, all DC is doing is making recommendations for what’s the best way to spend our nation’s medical care dollars. Unfortunately, as you will learn this is not the case.
Please refer to the chart prepared by the Joint Economic Congressional Committee outlining the new health-care requirements. As you can see, the complex bureaucracy involved in the implementation of Obamacare is daunting. Don’t you just love charts; it makes complex things more understandable. Well, in this case, maybe not let’s take a little stroll through this spider web of bureaucracy anyways to see where the IPAB board gets its marching orders and gets to decide what medical expenses are deemed necessary to pay and which ones are not.
As you can see at the center of this web of bureaucracy is the Health and Human Services (HHS) who oversees and governs implementations of the new law. If you follow the tentacle jetting from the lower left of the HHS epicenter, you will find the Centers of Medicare Services (CMS). It is just to the lower left on the route just pass their CMS Department of Actuaries. From there, the journey becomes a little more circuitous as you head a little North and then due West and you will run right into the Independent Payment Advisory Board (IPAB). You can’t miss it; it is on the left side of the chart half-way in between the President and your Physician. You’ll know you went the wrong way if you run into the IRS. Appropriately, they exist at top of the chart overseeing the entire health care matrix.
Now, wasn’t that fun? It would be, if it wasn’t actual reality. I wouldn’t recommend staring at this mind numbing chart too long or it may make you physical ill causing you to actually need medical care. Now, instead of just merely staring at this web of nightmares, you now become a real life patient that must actually physical coexist and survive in the medical enigma created called health care reform.
Let’s get back to the facts of how the system will work. The IPAB board will be forced by the Centers of Medicare Services (CMS) to meet the CMS projected spending “targets” or limits on Medicare expenditures. This board of 15 will play an unprecedented role in controlling what treatments, medications, and timely access to care Medicare will pay for. This will be a “cost-savings” in policy and inevitable rationing when the law is actual implemented. These “recommendations” in fact carry the force of law and require a 2/3 vote in the House and Senate to stop them, not an easy thing to do even during best of political environments in DC.
This may help to explain why this board has sometimes been referred to as a “Death Panel.” However, our seniors need not worry, because in the law it specifically forbids the IPAB Board of “rationing” care. However, in a recent interview with a strong defender of the creation of IPAB and Health and Human Services (HHS) Secretary, Kathleen Sebelius, admitted that the new law fails to define the word “ration.” I also was surprised to find out that she will have the opportunity to address this in the future, since as HHS secretary she will be required member serving on IPAB board of 15.
The gist of this story goes like this, The Appointed Secretary of HHS, Kathleen Sebelius, is responsible for directing the CMS to set “target spending limits” (code for rationing), on Medicare spending. Acting as a go between, the CMS then is responsible to force the IPAB members to make the mandatory “cost-savings” (code for cuts), to meet these spending “targets.” The same person who makes the original spending directive to the CMS, Kathleen Sebelius now sits on the very same board who makes same spending cuts which she ask for. And according to her, there is no conflict in interest, because the law “forbids rationing” health care despite neglecting to define the word “rationing” in the law. The rational being is that this is fair, because she is only a non-voting member on the board. On the other hand, Secretary Sebelius will still have ultimate authority and power over that same board in her role as acting Secretary of HHS. Is it becoming more apparent why this law has little support? Even the politicians who voted for it refuse to defend it.
Furthermore, the board gives a small group of un-elected appointed policy makers, the right to decide what Medicare will or will not pay for. If this is their cure on how to best care for our countries seniors, I would rather have the disease than the cure. The bureaucrats that sit on this rationing board, not the actual patients or their physicians, will be given the authority by law, to decide what life saving medical treatments, medications, and access to what doctors services are paid for. Does this sound like a fair deal to you? The law is now, cleverly being sold to you by using code words in the hope of convincing you that it is fair. Even, the inviting title of the story, “The Patient Protection and Affordable Care Act” is camouflage to conceal the deal our seniors will get. Is this story starting to sound similar to you? It is eerily familiar to a story I have once read, a story titled the HMO Model. We all know how that reads.
Stephen K. Badolato, MD
Diplomate Board of Family Medicine
Fellow in Specialty of Sports Medicine
Past President of Brevard County Medical Association