That's the question Jennifer Rubin is asking about over at the Washington Post today, and it's a good one. While Democrats have been all Mediscare all the time, no one's really asking about Obamacare's Independent Payment Advisory Board (IPAB). The president claims this will cut a trillion and a half dollars out of Medicare, but he leaves out the part where he actually explains how this will work:
It’s rationing, plain and simple. Or in more stark terms: The Ryan plan asks wealthier Medicare recipients to pay more; Obama’s plan denies care. Imagine if a Republican proposed a plan that, without any realistic reform element, simply said we’d pay much less for seniors’ care.
The Obama plan supposes that the 15 bureaucrats on the IPAB will unlock the wonders of cost control that have eluded us all. But it boils down to a confusion between costs and expenditures. The Obama plan will have us paying less but leave the underlying costs of medical care untouched.
Recall that cost-control was, after all, the basis for Obama’s health-care reform. In a white paper for the Galen Institute, Capretta wrote: “So the crucial question was always what to do about cost escalation. Or, more precisely, what changes in Medicare have the best chance of bringing about continual improvement in the productivity and quality of patient care?”
Rubin does an excellent job of explaining the serious pitfalls of the president's approach. However, she doesn't address one big problem with IPAB that I explained in last week's issue of THE WEEKLY STANDARD. The president's Medicare plan might well be unconstitutional and there's a serious lawsuit challenging it:
To date, almost all of the constitutional challenges to the new health care law have centered on its requirement that every American purchase health insurance. But in Coons v. Geithner, the Goldwater Institute, a right-of-center think tank in Arizona, is challenging the bill’s constitutionality on the basis of IPAB.
Whether Congress can simply offload its legislative responsibility for Medicare to a commission in the executive branch is a serious question regarding the separation of powers.
“The bottom line is what this board is going to be doing is not making recommendations to Congress. They’re really going to be passing law. The statute actually calls it ‘law’ throughout the Patient Protection and Affordable Care Act,” says Diane Cohen, the Goldwater Institute’s lead attorney. “Congress doesn’t have to pass them, the president doesn’t have to sign them. So it’s taking over a historically congressional responsibility and duty—and here comes the legal mumbo-jumbo—without any ‘intelligible principles’ to guide this board.”
Unlike other federal agencies with regulatory powers, IPAB is subject to no external review process—no public notification in advance of proposed rules, no opportunity for public comment, no administrative guidelines, and no judicial review. Cohen sees Congress as “just abdicating” its responsibility “because they can’t withstand political pressure.”
There's a lot more particulars to be explained, so be sure and read the rest. Also, Stanley Kurtz's take on IPAB, like everything else he writes, is well worth your time.