Republicans don't believe Medicare should be preserved in current form, so they've pushed to either fully or partially privatize it, ending the coverage guarantee in favor of a subsidized private insurance system for the elderly. Despite some reservations within their ranks, Democrats offered up IPAB as an approach to contain the explosive growth of Medicare spending in the coming decades.
IPAB would comprise 15 Senate-confirmed experts tasked with holding down Medicare payments to providers starting around 2017 -- it would not have the authority to touch benefits. The GOP's alternative plan by Paul Ryan achieves cost-control by limiting benefits, and Republicans have since unveiled less harsh versions of the same concept in an effort to soften criticisms.
Establishment liberals are catching on to the perils of scrapping the board. A new analysis released Monday by the Center For American Progress, a think tank with ties to the Obama administration, mounts a defense of the panel, clarifying that the two choices for Medicare's future are IPAB and a Ryan-style privatized system that shifts costs to seniors.
"Repealing the board would increase federal budget deficits and the federal debt, and put the Medicare program at risk," wrote Topher Spiro, who runs health policy at CAP. "By contrast, alternatives to the Independent Payment Advisory Board such as premium support would ration care by shifting costs to beneficiaries, making the care that they need less affordable." Spiro argues that various areas of provider reimbursement can be cut without damaging seniors' access to care, including insurance and drug company overpayments.
Just last week, President Obama's top health care adviser Nancy-Ann DeParle defended IPAB on the White House website, particularly as it compares to the GOP's private insurance vision.
Republicans are conscious that a successful IPAB would negate the need for a premium support -- or voucher -- system, and want to smother it in its cradle. And though IPAB, unlike the GOP's vision, is signed into law, Republicans have waged an aggressive and uncountered legislative and messaging campaign against it: they've threatened to block Senate confirmation of any appointees (and they can), while House Democratss, under enormous pressure from the health care industry, are joining the GOP push to repeal IPAB. It remains to be seen whether any Senate Dems will join them.
Energy & Commerce health subcommittee Chairman Joe Pitts (R-PA) warned Monday that IPAB "will resort to de-facto rationing." Vice Chair Michael Burgess (R-TX) ominously declared, "You know what this sounds like? It sounds like rationing."
Their qualms obscure the stakes. As a finite resource, health care is already rationed, and will by definition continue to be rationed. With Medicare spending set to explode, and Congress in the grips of a collective-action nightmare, the question is whether health care for the elderly will ultimately be rationed by government-appointed experts, or by private insurance companies with a profit motive.
That's what the battle really comes down to.