Democratic Rep. Allyson Schwartz of Pennsylvania has called for the repeal of the Medicare Independent Payment Advisory Board, or IPAB, which was created by the national health care law she voted for to control costs. President Obama has proposed expanding the board as part of his response to Rep. Paul Ryan's plan to overhaul Medicare.
IPAB is effectively a rationing board comprised of a panel of experts that determines the most efficient way to spend money. But Schwartz, in a USA Today op-ed, argues:
We all agree that Medicare costs must be contained and that the payment system is flawed and needs to be replaced. But simply cutting reimbursements is not the answer. IPAB brings unpredictability and uncertainty to providers and has the potential for stifling innovation and collaboration.
The threat of reduced payments is the least imaginative option and most unlikely to result in the kind of heath care we know seniors and all Americans deserve.
The congresswoman is a bit optimistic about the ability of delivery reform to generate the cost savings necessary to tackle the nation's crushing long-term debt crisis, but aside from the policy, the politics of this is interesting.
Schwartz is from a district that Cook Political Report rates as solidly Democratic and one of the safest in Pennsylvania for her party. But Pennsylvania is one of the oldest states in the nation. With the New York 26th special election slipping away from Republicans, we're likely to hear a lot about the backlash against the Ryan plan. But Schwartz's decision to come out for repealing IPAB suggests that Democrats may also be feeling vulnerable to attacks on IPAB.
This could prove an important development. If the battle is between the Ryan plan and some fairy tale scenario in which no changes are made to existing entitlement programs and we reduce the debt through magic pixie dust, then Ryan loses. But if the battle is between two different ways to reduce spending on Medicare -- one in which a centralized board of 15 experts makes the decisions, or one in which individuals are given money to make decisions about how to economize -- the Ryan plan could win.