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Public Statements

An Unaccountable Medicare Board

Op-Ed

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By Congressman Joe Pitts

Here in the United States we pride ourselves on our representative form of government. All law-abiding citizens are given the right to elect their local, state, and federal representatives. These representatives are, in turn, responsible for managing the government. Regular, fair elections ensure that these legislative and executive officials are responsible to the people.

Our system is by no means perfect. Elected officials are people with the same imperfections as any man or woman. As Winston Churchill noted, "No one pretends that democracy is perfect or all-wise. It has been said that democracy is the worst form of government except all those other forms that have been tried from time to time."

When we passed the health care reform bill last year, I did not think that we fully understood what was being signed into law. Even Speaker Pelosi admitted that we could only find out everything that was in the legislation after we passed it.

Now we are learning more about a Medicare advisory board that undermines our democracy, taking decisions out of the hands of Congress and placing them into the hand of 15 unelected bureaucrats.

Medicare is clearly in need of better management. Right now, the program is set to go bankrupt in 2024. Over the next 75 years, the program faces costs not covered by the Medicare tax of $30 trillion.

The law created the Independent Payment Advisory Board (IPAB) to reduce Medicare costs. The members of the board are appointed by the President and confirmed by the Senate. While they are supposed to be confirmed, the President certainly has the power to appoint board members with a recess appointment. IPAB could begin its work without a single member testifying before a Senate committee and being approved on the Senate floor.

While the board is directed to cut Medicare spending, they are limited in what they can actually do to reduce costs. For the first few years of IPAB, they can only cut costs in Medicare Advantage, prescription drugs, and skilled nursing facilities. Together, these three areas only represent 39 percent of total costs. After 2020, IPAB will have power over a broader range of expenses, including hospital services.

The law says that the cuts made by IPAB cannot lead to rationed care, but the natural result of the deep cuts they will be forced to make will be rationing. The law is deeply dishonest on this point. It does not define the term rationing. How can the board be expected to prevent rationing if they do not even have the term defined for them?

Congress, seniors, and doctors will have little to no input into the decisions made by IPAB. While the law establishes a consumer committee to advise the members of IPAB, the board has no responsibility to listen to their advice. The recommendations will be forwarded to Congress where only a two-thirds vote of both the House and Senate can overturn these decisions. Additionally, IPAB's decisions cannot be challenged in court.

Both Republicans and Democrats recognize that IPAB is a threat to representative government and to the quality of Medicare. Philadelphia-area Rep. Allyson Schwartz (D-PA) has joined with Rep. Phil Roe (R-TN), a medical doctor, to introduce legislation repealing IPAB. At a hearing on IPAB this week, the Energy and Commerce Health Subcommittee Ranking Member, Rep. Frank Pallone (D-NJ), sat next to me and said, "We don't need IPAB."

We do not need unaccountable bureaucrats cutting Medicare over the objection of a majority in Congress. Medicare is the people's health care program, and important decisions about benefits should be made by the people's representatives.

It will not be easy to fix Medicare to keep it healthy for future generations. It will require bipartisan agreement and compromise. If these decisions are made by Congress, I believe that the people will be able to trust that they were made for the good of the program. If such decisions are made behind closed doors by bureaucrats who will never answer to voters, then we have compromised our democracy.

There is bipartisan agreement that IPAB is the wrong way to fix Medicare. I hope that we can come together across the aisle to repeal this board before it begins working.


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