President Obama faces opposition from both Republicans and Democrats on the Independent Physicians Advisory Board (IPAB) -- the most potent cost-cutting tool in the health reform law. Remember: The IPAB, which would be composed of physicians, would have the power to set Medicare payments for services based on comparative effectiveness research. The IPAB would, for example, be able to have Medicare pay lesss for procedures that are shown to be less effective.
While Democrats obviously supported the reform law, some now seem queasy about the prospect of the IPAB's real power -- a power that similar panels such as the Medicare Payment Advisory Commission and the Physician Practice Advisory Committee -- never had.
"Congress is a representative body and must assume responsibility for legislating sound health care policy for Medicare beneficiaries, including those policies related to payment systems," writes Rep. Allyson Schwartz (D-Pa.) in a letter to other lawmakers, asking them to repeal the IPAB provision. "Abdicating this responsibility would undermine our ability to represent the needs of the seniors and disabled in our communities. I cannot condone the implementation of a flawed policy that will risk beneficiary access to care."
For the record, Congress has the power to veto anything that comes out of IPAB, though it requires a majority vote to do so and the President can overturn the Congressional decision with a veto. Like any presidential veto, Congress can override it with a two-thirds majority.
Critics on the right say the IPAB is proof positive that health reform will bring about "death panels," giving the board control over allowing certain procedures and thus lives of Medicare recipients. Supporters of IPAB point out that, if so, this would be a panel that "kills" by having Medicare pay much less for services that haven't been shown to be effective, and by having a majority of people in Congress agree to its decision. In other words, IPAB can't "kill" anybody unless Congress signs off on it.
It's naturally up for grabs whether effectiveness research is a good foundation for IPAB's payment decisions. You might say that what's effective for many may not be clinically appropriate in every single case -- sometimes a doctor might opt for a less effective treatment that works better anyway for a particular patient. Herein lies the potential weakness of the panel.
Supporters of IPAB say that there is no better way to tamp down the spectacular skyward trajectory of Medicare's costs.