Why don’t House Republicans replace IPAB with Paul Ryan’s proposed boards?

Aaron Carroll highlights the hypocrisy of House Republicans saying ‘we have to cut Medicare’ and then adopting rules for the 113th Congress that say they will ignore the work of IPAB, whose purpose is, you guessed it, to cut the cost of Medicare if it rises faster than GDP + 1%. I have no idea if it is legal for the House to put in their rules that they won’t follow the law, that is not my point here.

I have been ranting about how the Republicans have controlled the House for 2 years now, and have yet to get specific on what they are for (mark up a bill, get a CBO score, move it to a full vote) on health policy. In the spirit of helpfulness, I have an idea. They could pass a simple bill to replace IPAB (a board of 15 experts) with the two board of experts (one of 5 members, the other of 15) that Rep. Paul Ryan proposed as part of his 2009 (111th Congress) health reform bill the Patients’ Choice Act (title VIII to be exact). I have long said I understand Republican savagery of IPAB to be quite hypocritical given such leaders of the Republican party proposed a bill with boards about 1 month prior to the Commerce Committee reporting the first version of the HR3200 back in June, 2009 (me prattling away in July 2011 about this here, here and Rep Ryan’s spox responded here). But, no one seems to care.

Lost in my ranting is my belief that there is some pretty reasonable health policy in Title VIII of the Patients’ Choice Act. In what must be one of the worst predictions ever, I wrote in July, 2009 that the existence of these boards in the Republican Patients’ Choice Act, and the (then called IMAC) board in the emerging Affordable Care Act meant that the use of such boards patterned on the Base Closing Commission represented an emerging bipartisan consensus that some difficult health policy decisions needed to be taken away from Congress.

IPAB actually has a much narrow brief than do the PCA boards since it can only focus on Medicare, and then can only propose changes in Medicare reimbursement rates. By comparison, the PCA boards would likely be far more consequential. You really should go read it for yourself, but just to highlight, the 15 member board (Forum for Quality and Effectiveness in Health Care) proposed by Rep. Ryan would:

• Have the goal of promoting transparency in price, quality, appropriateness, and effectiveness of health care (sec. 813, p. 211-12)
• Will create guidelines to reach this goal (sec. 813, p. 212)
• Guidelines must follow standards of research and the best evidence and present findings in an understandable format ( sec 813, p. 212)
• To develop guidelines, the Director of the Commission can contract with outside, private entities to complete research (sec 813, p. 212)
• The Board was to bring forth recommendations each year, and not only when certain cost inflation targets were not met as with IPAB (sec 814, p. 213-14)
• The Board has more teeth than the IPAB. Here I will simply reproduce the text of the Patients’ Choice Act, sec. 814(a)(b)(1)-(2) p. (214):

(b) ENFORCEMENT AUTHORITY.—The Commissioners, in consultation with the Secretary of Health and Human Services, have the authority to make recommendations to the Secretary to enforce compliance of health care providers with the guidelines, standards, performance measures, and review criteria adopted under subsection(a). Such recommendations may include the following, with respect to a health care provider who is not in compliance with such guidelines, standards, measures, and criteria: (1) Exclusion from participation in Federal health care programs (as defined in section 1128B(f) of the Social Security Act (42 U.S.C.1320a–7b(f))).(2) Imposition of a civil money penalty on such provider. [emphasis mine]

That is for the entire health system, not just Medicare.

Now scoring what these boards would do to cost would be tricky, but Republicans could commiserate with the writers of ACA on this. And as Reihan Salam said this week, we need to not only focus on short term savings, but true transformative changes are needed in health care to improve quality and hopefully reduce costs. I agree. I think the two boards proposed by Republicans in the Patients’ Choice Act could be quite useful. If the House Republicans tried to pass stuff like this, then they could correctly claim to be pursuing a positive agenda on health policy/costs and I could stop ranting.