Posts Tagged ‘Independent Payment Advisory Board’
July 31st, 2012 at 12:30 pm
Government Chasing Doctors Out of Practice
Posted by Print

Over the weekend a New York Times profile of my (and Ashton’s) hometown of Riverside, California sounded the alarm over the crisis-level shortfalls of doctors practicing in America. For a publication as married to do-gooder liberalism as the Times, it’s tone was surprisingly fatalistic:

The Association of American Medical Colleges estimates that in 2015 the country will have 62,900 fewer doctors than needed. And that number will more than double by 2025, as the expansion of insurance coverage and the aging of baby boomers drive up demand for care. Even without the health care law, the shortfall of doctors in 2025 would still exceed 100,000.

Health experts, including many who support the law, say there is little that the government or the medical profession will be able to do to close the gap by 2014, when the law begins extending coverage to about 30 million Americans. It typically takes a decade to train a doctor.

Well, there is at least one thing the feds could do: get out of the way. A helpful explainer from the Heartland Institute shows how badly government distorts the market for doctors:

[The Heritage Foundation’s Kathryn] Nix points out that when Congress passed the 1997 Balanced Budget Act, it included a cap on the number of residency positions Medicare is allowed to fund. The step wasn’t controversial at the time, and in fact it had the support of multiple organizations, since concerns abounded at the time that the United States had an oversupply of physicians.

Since then, the number of residency positions funded by Medicare has remained unchanged, capped at 1996 levels despite exploding population growth and increased demand. Groups such as the Association of American Medical Colleges (AAMC) and the American Medical Association (AMA) have since changed positions and now support increasing the 1996 cap or eliminating it entirely.

“The biggest concern is that the demand is going up as the population ages,” Nix continued. We’re going to have more people on Medicare, elderly who need more medical attention. The new health care law will exacerbate the problem, first of all by increasing and subsidizing demand, but several of the provisions of the new law will discourage physicians from staying in the profession and will discourage young people from joining it.”

An utterly avoidable human tragedy, bred by ignorance. Who could’ve anticipated that capping supply would lead to shortages? Anyone who’s ever cracked a basic economics textbook, that’s who. We can argue over the proper methods for restructuring Medicare, but it should be obvious that “restrict the number of doctors and leave everything else the same” isn’t going to cut it.

And this is just the tip of the iceberg. As has been widely noted, Obamacare’s virtually indestructible Independent Payment Advisory Board has the potential to morph into precisely the kind of “death panel” Sarah Palin warned about.

Bureaucratic incompetence has long been a bugbear of conservatives. But the day is soon arriving when the bean counters will go from costing money to costing lives.

April 25th, 2011 at 1:01 am
More on “Who Decides?”

In my last post, I explained that Obamacare’s Independent Payment Advisory Board (IPAB) would cut far more Medicare services, without giving patients any real choice in the matter, than Rep. Paul Ryan’s budget proposal would ever do — and that Ryan’s would give patients control, whereas IPAB would leave them at the mercy of bureaucrats far removed from the scene. Again, the issue is, who decides?

That’s the theme in areas other than IPAB, too. Indeed, it is the central question of Obamacare. Obama’s system and its corollaries leave all authority in the hands of central planners — disembodied persons, as far as the patient is concerned, for whom the patients are little more than statistics on a spread sheet.

Fox news contributor and former Reagan-Bush in-house thinker James Pinkerton is rightly banging the drum for more options for patients and providers alike. In what he calls a “Serious Medicine Strategy,” Pinkerton explains that the best way to keep costs down is to encourage the development of cures rather than of merely managed treatments. As Pinkerton says, healthy people are less expensive than sick people. Therefore, intellectual property rights for researchers should be protected better, or longer, than they are now. The FDA should be more lenient, or more rapid, in approving medicines — at least for trial use, with appropriate warnings, perhaps. And so on. The idea is to provide more chances for more cures, and more choices for everybody involved — mostly through the free market.

There is a lot more to say on this and related topics. Again, though, the central message is this: Where bureaucrats and central planners exert too much control, or interfere too much, the ultimate provision of services is likely to be either worse, or more expensive, or both. But if people are freed to pursue their own best interests. They will. More on this as the weeks go by.

April 21st, 2011 at 11:03 am
On Death Panel, Who Decides?

Who decides? That is the most important question when it comes to Medicare savings. First, some background:

Conservatives suddenly are abuzz again with talk of an Obamacare “death panel,” and in substance they have a point: If the Independent Payment Advisory Board (IPAB) works anything like its model in Oregon… and if government health-care programs effectively crowd out private options so that the bureaucratic decision-makers in the government program are, for all intents and purposes, the ultimate arbiters of who receives which treatments… then people have serious reason to worry that their lives could be foreshortened by government fiat. Employing the phrase “death panel” has its advantages and disadvantages (the biggest of the latter is that it keeps the establishment media from giving the complaint any credence, even though the problems with IPAB are both real and acute), but the board’s potential for harm is evident in the fact that 72 Democratic House members last year joined Republicans in asking for the panel to be removed from the bill.

Meanwhile, the anti-Obamacare lawsuit which takes on IPAB directly (among other things), led by the Goldwater Institue, seems to me absolutely on target in challenging how the board is set up to be a power unto itself with no congressional oversight of any relevance or weight. That suit merits far more attention, via full columns rather than quick blog mentions, and conservatives are foolish not to rally in support of it.

With all the anti-IPAB talk bubbling up right now, though, the talk has been strangely disconnected from the budget debate that has been front and center of the American political universe for weeks. Yet with President “Don’t Interrupt Me” Obama jetting all over the country to spread demagogic scare tactics against the Medicare portion of Rep. Paul Ryan’s budget proposal, those on the right really haven’t done much to parry the specifics of his attacks on the “voucherization” or “privatization” of Medicare. Yet the fact is that the president aims to save almost as much money from Medicare as Ryan does — except that he wants to use IPAB to do it.

That’s why conservatives should take up his challenge. We should answer that it is he, not we, who is (/are) for “cutting” Medicare. He does it by giving vast powers to unelected bureaucrats almost entirely unanswerable to Congress. We achieve savings, which may not involve actual cuts in care at all, by giving power to the patients themselves. Conservatives should do a very specific poll on Medicare Part D. If, as I suspect, it is still a highly successful program, then conservatives should say that all Ryan wants to do is to make all of Medicare work the same way that Part D does — except without the doughnut hole. The idea is to allow seniors themselves to achieve savings while finding the best care they can.

We save; Obama cuts. More importantly, we give the power to the patients; he gives it to bureaucrats with a mandate to chop costs by unaccountable orders.

So the question is, Who decides: The individual patient, or the government commissars?

When phrased like that, conservatives don’t even need to say the phrase “death panel.” For most listeners, the scary implications of Obama’s approach will be clear.