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Barack Obama signing Affordable Care Act
President Obama signing the Affordable Care Act
Last month, Gov. Howard Dean penned an op-ed for the Wall Street Journal in which he called a key cost-controlling measure of the Affordable Care Act, Independent Payment Advisory Board (IPAB) "essentially a health-care rationing body," adding his voice to the chorus of attacks, usually coming from Republicans, on the board. He didn't call it a death panel, like Republicans do, and did praise the overall law, but he also opened up room for vulnerable Democrats to hop on the partial repeal bandwagon.
A wave of vulnerable Democrats over the past three months has signed on to bills repealing the board’s powers, including Sen. Mark Pryor (Ark.) and Reps. Ron Barber (Ariz.), Ann Kirkpatrick (Ariz.), Kyrsten Sinema (Ariz.) and Elizabeth Esty (Conn.).

All five are considered vulnerable in next year’s election, highlighting the stakes and the political angst surrounding the healthcare measure. [...]

Two of the lawmakers explained their opposition by suggesting the board would limit care for Medicare patients.

Let's just go back, again, to what IPAB can and cannot do, by law.
There are some things the IPAB can do, some things it may do, and some things it is prohibited from doing. It can propose changes in how some providers are paid or how care is organized. Congress may substitute other ways of reaching the spending targets, but if it does not, the IPAB recommendations take effect. The IPAB may suggest ways to change the health care system outside Medicare. But these recommendations have no binding legal force. The IPAB is prohibited from making any recommendations that would result in health care rationing or that would change Medicare benefits, premiums, deductibles, or cost-sharing.
It can't, by law, ration care. Period. At this point, any power it does have is actually theoretical. It would only kick in if projected Medicare spending exceeded a target level, at which point it makes recommendations on how to reduce Medicare spending. Those recommendations only actually happen if Congress doesn't come up with another solution, and—all together now—it cannot make recommendations that "would result in health care rationing or that would change Medicare benefits, premiums, deductibles, or cost-sharing."

Also, too, it's all theoretical because the 15-member board doesn't exist right now and won't in the near future because the positions have to be nominated by the president, and confirmed by the Senate. Like Republicans are gonna let that happen. Also, too, the CBO says increases in Medicare spending have slowed to the point that the spending target where the IPAB kicks in isn't likely to be reached until 2022.

There is no reality-based reason for Democrats to jump on the repeal IPAB train. None. Unless your reality includes the fact that the American Medical Association, the American Hospital Association and the pharmaceutical lobby have supported IPAB repeal, are all lobbying you to do so, and tying their potential support of your next campaign to it.

Originally posted to Joan McCarter on Thu Aug 08, 2013 at 01:16 PM PDT.

Also republished by Daily Kos.

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Comment Preferences

  •  Tip Jar (18+ / 0-)

    "The NSA’s capability at any time could be turned around on the American people, and no American would have any privacy left, such is the capability to monitor everything. [...] There would be no place to hide."--Frank Church

    by Joan McCarter on Thu Aug 08, 2013 at 01:16:04 PM PDT

  •  They really (6+ / 0-)

    Need to roll out the medicare expansion soon. That will help so many people.

  •  If they're vulnerable they'd be (12+ / 0-)

    smart to take a stand FOR affordable health care.  The Republicans don't seem to be getting the love during their break. Suck it up, quit being of afraid of "liberal", stand for your constituents.  

    I'm not looking for a love that will lift me up and carry me away. A love that will stroll alongside and make a few amusing comments will suffice.

    by I love OCD on Thu Aug 08, 2013 at 01:29:45 PM PDT

    •  amen (7+ / 0-)

      They need to highlight the individual aspects of ACA that poll really well like doing away with pre-existing conditions.  They can still hem and haw if they want to about ACA not being perfect overall.

      Then they need to remind voters of what plans the Repubs have proposed in the last 20 years:

      1) RomneyCare in MA
      2) paying for healthcare with chickens
      3) going to the emergency room

      I'm not liberal. I'm actually just anti-evil, OK? - Elon James White

      by Satya1 on Thu Aug 08, 2013 at 01:39:04 PM PDT

      [ Parent ]

    •  Agreed (7+ / 0-)

      I attended an Enroll America brown bag lunch today at the Harris County Democratic headquarters.  It was standing room only and the staff was a little surprised by the turnout.  I wasn't.  I think people want better and cheaper health care and they are more pragmatic than most of us give them credit for. That goes for Republican constituents, too.

      Two cases in point.  I met a Republican woman on a cruise recently who was married to an independent oil & gas consultant here in Houston and she had a pre-existing thyroid condition that made it damn near impossible to get insurance and she told me at dinner she was eagerly anticipating ACA and hoped it wouldn't get derailed.  I also have a former co-worker who retired early from banking in 2007.  At about the same time, her husband decided to start up a consultancy business.  He was doing well, they had substantial savings and assets, but then he died unexpectedly.  She had to purchase medical insurance that was extremely expensive.  Needless to say, she's another Republican who sees the benefits of ACA.  

      I'm not sure Cruz and Lee can drum up the grassroots support they seem to think is out there.  They have courted small business owners and the self employed in the past, but I think a breakup is on the horizon as many people start to realize what's on the table.

      We are all in this together.

      by htowngenie on Thu Aug 08, 2013 at 04:01:23 PM PDT

      [ Parent ]

  •  The established standard, within the party (1+ / 0-)
    Recommended by:
    cynndara

    and as expressed by all the self-styled pragmatists, on this site & elsewhere is to respond to all challenges by moving ever rightward. If one assumes that challenging the medical delivery via insurance only plan is, a move to the right, then such behavior is correct.

    That, in its essence, is fascism--ownership of government by an individual, by a group, or by any other controlling private power. -- Franklin D. Roosevelt --

    by enhydra lutris on Thu Aug 08, 2013 at 03:25:00 PM PDT

    •  I don't understand what you posted. (1+ / 0-)
      Recommended by:
      Sybil Liberty

      Are you saying True Democrats should run against the ACA?  That's what it sounds like, but it's so strange I had to ask.

      I'm not looking for a love that will lift me up and carry me away. A love that will stroll alongside and make a few amusing comments will suffice.

      by I love OCD on Thu Aug 08, 2013 at 03:38:37 PM PDT

      [ Parent ]

      •  One has to decide who true Democrats are. (2+ / 0-)
        Recommended by:
        RickD, cynndara

        Barbara Lee is in no trouble electorrially and can do as she pleases, but the accepted wisdom for Dems in districts/states polling less than Obama+15 or so is that they should move to the right to win votes if they are feeling any pressure from opposition candidates. I do not personally espouse that. That is DLC, DNC, DCCC, DSCC, New Dems, Third Way, and other self-styled "pragmatists", but they will be the first to tell you that they are the "True Democrats".

        If you accept that paradigm, then whether to challenge the ADA depends upon whether or not such a move is seen as right wing. IMHO, that depends on the specific provision in question, but none of my opinions n the matter are legitimate because I am not of the right wing.

        That, in its essence, is fascism--ownership of government by an individual, by a group, or by any other controlling private power. -- Franklin D. Roosevelt --

        by enhydra lutris on Thu Aug 08, 2013 at 03:52:36 PM PDT

        [ Parent ]

        •  Thanks for clarifying. That's my belief too- (1+ / 0-)
          Recommended by:
          enhydra lutris

          I know the 50 state thing Howard Dean started means we get conservative Democrats.  I vastly prefer them to ANY Republican but the point is, once elected, teach people why Democrats are preferable, don't keep jogging right.  Slide left and take them with you.  Run on Obamacare.  Run on gun control.  Send the Gunfail Diaries to every voter.  Run on choice, point out that forced birth is not pro-life.  If it was, 0% hungry children would be our norm.  Embrace being a liberal. Mock conservatives for blocking every forward move since day one.  

          I'm not looking for a love that will lift me up and carry me away. A love that will stroll alongside and make a few amusing comments will suffice.

          by I love OCD on Thu Aug 08, 2013 at 06:30:37 PM PDT

          [ Parent ]

  •  RIP my respect for Howard Dean. (0+ / 0-)

    He has sold himself to lobby.

    •  Your RIPping your respect. (0+ / 0-)

      Because Howard Dean wrote an article. One month ago. That caused Democrats to sign onto bills. Three months ago. You do realize that three is more than one, right?

    •  haven't read the full context of Dean's remarks, (0+ / 0-)

      but yea, with friends like that...

      my first impulse

      "Show up. Pay attention. Tell the truth. And don't be attached to the results." -- Angeles Arrien

      by Sybil Liberty on Thu Aug 08, 2013 at 03:55:19 PM PDT

      [ Parent ]

    •  Read the f-ing op-ed. (0+ / 0-)
      If Medicare is to have a secure future, we have to move away from fee-for-service medicine, which is all about incentives to spend more, and has no incentives in the system to keep patients healthy.
      Gov. Dean's point is that trying to improve health care by "controlling costs" neither improves health care nor reduces costs. Just because he declines to "clap harder" for that particular pixie (IPAB) doesn't mean he's on the wrong side.

      Now he skates past proposing what we should do instead, exactly. After all, he's on the WSJ op-ed page here, they'd never print it if he proposed what he really wants!

      -Jay-
      
      •  Disagree. Here's why: (0+ / 0-)

        Cost and quality can't really ever be separate. Do you go to buy any tomato or car? No, you look at the cost/quality trade off. Problem is: health care quality and cost is especially impossible to ascertain.  Thus, you need a single payer system done like Germany. Govt sets quality standards, coverage parameters, sets standards, requires full coverage, sets prices. Private companies compete within this framework on a level playing field....I get tired of people looking for "market-based cost containment."  It really doesn't work to keep trying to find and fill all the loopholes private companies will find to increase costs and minimize quality.  Though Obamacare is a great start - and would have been better without Supreme Court interference.

  •  Do you see the disconnect ... (0+ / 0-)

    between "last month" Dean wrote an article and "over the past three months" Democrats have signed onto bills? Unless Howard Dean used the Wayback Machine, how did his article affect those Democrats?

    •  haven't read Dean's comments in context, (1+ / 0-)
      Recommended by:
      argomd

      but there are surely more than a mere "5 vulnerable democrats"...

      So if Dean has given them all (a dozen or two would be my guess) license to repeal?

      ...who TF needs enemies?

      "Show up. Pay attention. Tell the truth. And don't be attached to the results." -- Angeles Arrien

      by Sybil Liberty on Thu Aug 08, 2013 at 04:02:05 PM PDT

      [ Parent ]

    •  What is disconnected (2+ / 0-)
      Recommended by:
      madronagal, argomd

      Is that Democrats always shoot their own.

      Doesn't matter when he wrote it; it is a gift to Republicans.

      Exactly like Andrea Mitchell dissing NBC for allowing a movie about Hillary.

      Screw all those people. I might as well watch FOX.

    •  You didn't understand that I was dissing Dean... (0+ / 0-)

      For his op-Ed itself, not because I saw a cause and effect related to what these Dems did.So the chronology is irrelevant to me. Dean sold out, as far as I'm concerned.full stop.

  •  Follow the money (4+ / 0-)

    If we do we'll see who does what for whom.

    They want to chip away at Obamacare until it is not revoked but irrelevant.

    As a Single Payer supporter I want Obamacare to succeed and become a step on the way to Single Payer thanks to the very useful "innovation waiver".

    Daily Kos an oasis of truth. Truth that leads to action.

    by Shockwave on Thu Aug 08, 2013 at 03:51:19 PM PDT

    •  too little too late (4+ / 0-)

      Come October the exchanges are going to open in many states, allowing a lot of people access to cheaper health care than they can currently get directly from providers.

      Once that happens, it'll  be much harder to get any anti-ACA momentum moving.

      Except, of course, in the House Republican caucus, where "vote to repeal Obamacare" is apparently part of some sick drinking game.

      •  I have fond memories of college drinking games (0+ / 0-)

        And I was usually the first one to get so bombed I had to stagger off to bed.  So, when are the Republicans going to get so bombed they have to stagger off to bed?

        "We have always known that heedless self-interest was bad morals, now we know that it is bad economics." Franklin Delano Roosevelt, Jan. 20, 1937

        by Navy Vet Terp on Thu Aug 08, 2013 at 04:08:29 PM PDT

        [ Parent ]

  •  Howard Dean isn't that great. (0+ / 0-)

    He has a paying gig that has moved him rightward. Sometimes I want to throw things at the TV when he talks.

  •  Pity . . . (1+ / 0-)
    Recommended by:
    JayBat

    "The IPAB is prohibited from making any recommendations that would result in health care rationing . . ."

    Because one thing we NEED is a little rationing, of frivolous, futile, duplicative, redundant, and inefficient "care".  Far too many of our most vulnerable are subjected to endless interventions with little or no chance of success, done mainly to enrich the health-care providers.  This is not care; it is exploitation.  Unnecessary medical intervention inevitably carries risks, even when it's merely the risk of picking up additional airborne infections caused by coming into a waiting room full of sick people for an unnecessary appointment for an unnecessary checkup or non-invasive test.  As long as we provide medicine under a for-profit model, the incentives will remain for providers to pad their receipts by demanding more treatment than patients actually need.  And since most patients will be either too sick or too intimidated to second-guess their providers, SOMEBODY has to do it for them.

  •  gutless politicians (0+ / 0-)
    " It can propose changes in how some providers are paid or how care is organized. Congress may substitute other ways of reaching the spending targets, but if it does not, the IPAB recommendations take effect. "
    This, for all intents and purposes, is rationing.

    When gutless politicians ignore problems because the fixes would hurt them in elections, the lay the responsibility at the feet of appointed bureaucrats.....like IPAB.

    Every single thing that has to happen for IPAB to have its recommendations take effect....will.  Politicians on both sides of the aisle will pass the buck on unpopular decisions.

    Rationing is inevitable.  I can understand the reality of limited resources, except the elitist Washington DC crowd are always exempted.  We have to live by one set of rules, and our new aristocracy another.  

    That is why the ACA will never work.  Its not a solution to any problems, its a carve out for the government and their friends while the rest of us pay.

    I cant think of one promise made about the ACA that has been kept.  Try getting into the "preexisting conditions" group.  Its already been "filled up" Its a fraud. The more i learn about it, the more i realize it was written by special interests for special interests.

    Try reading through the ACA.  You will have much less faith in it.

  •  There are times when I wish Howard Dean would (2+ / 0-)
    Recommended by:
    Matt Z, JBraden

    just scream maniacally rather than talk.  This is one of them.  

    Fighting for peace is like screwing for virginity -- George Carlin

    by ZedMont on Thu Aug 08, 2013 at 05:50:20 PM PDT

  •  Kyrsten Sinema sold the bill in AZ (0+ / 0-)

    I went to an ACA town meeting in Prescott, AZ back when it was still becoming reality. Kyrsten Sinema was the host of the meeting. She was actually terrible at doing this, and was incredibly condescending toward people who had concerns with the bill, especially those who had concerns from the left. Now she has problems with it? Bite me.
    She always stuck me as the worst sort of Democrat left-leaning on some random social stuff, but willing to be a cipher to be filled with right wing stuff on everything else.

    The Republican Party: The Bridge to Nowhere

    by flounder on Thu Aug 08, 2013 at 06:16:58 PM PDT

  •  Look at N.I.C.E. - the group that does this for (1+ / 0-)
    Recommended by:
    nomandates

    the UK health service.

    http://guidance.nice.org.uk/

    Mostly it's looking at new procedures and checking if they are better than the existing procedures.
    * If the new is not as good then it's not approved.
    * If it is just as good then it is only approved if it is the same price.
    * If it is better than the old treatment but much more expensive then it is approved for use only where the old treatment isn't effective.

    Their evaluations are available to all doctors so they don't need to depend on information from drug companies in their perscribing.

    Drug companies don't like it.

    •  Interesting comment, Joe Ra. (0+ / 0-)
      Their evaluations are available to all doctors so they don't need to depend on information from drug companies in their perscribing.

      Drug companies don't like it.

      I bet they don't!

      Thanks for providing this information.

      Welcome from the DK Partners & Mentors Team. If you have any questions about how to participate here, you can learn more at the Knowledge Base or from the New Diarists Resources Diaries. Diaries labeled "Open Thread" are also great places to ask. We look forward to your contributions.

      "Compassion is not weakness, and concern for the unfortunate is not socialism." Hubert H. Humphrey

      by nomandates on Thu Aug 08, 2013 at 10:04:28 PM PDT

      [ Parent ]

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