President Obama has been very selective on which parts of Obamacare he wants and doesn’t want to implement, and when. And one much-ballyhooed part he has unilaterally chosen not to initiate is his “death panel.”
The panel is officially known as the Independent Payment Advisory Board (IPAB). It’s supposed to be made up of appointed experts who would set health care and pricing policies for Medicare. Those policies would then likely be embraced by health insurers in the private market, as happens now.
The public had a quick and visceral negative reaction to the notion that there would be a panel of unelected bureaucrats deciding which medical treatments patients could and couldn’t have. And although the predictions of ominous medical rationing were a bit hyperbolic, the panel had (and could still have) the potential for becoming a rationing machine.
However, more than four years after the Affordable Care Act’s passage, Obama has yet to nominate one person to the IPAB—which makes it about as useless as his promise that if you like your health insurance plan you could keep it.
Why has he been as AWOL on the IPAB as he was on the VA health care system? For one thing, the growth in Medicare spending has slowed somewhat over the past six or seven years, reducing the pressure for top-down bureaucratic action.
But the more important issue may be that the president doesn’t want a political brawl over the IPAB appointees, especially right before an election. He would likely favor single-payer advocates—like himself, Rep. Nancy Pelosi, Sen. Harry Reid, and Obama’s first nominee to run the Centers for Medicare and Medicaid Services, Donald Berwick—for the jobs. But such appointments would only fuel conservative reaction and energize disgruntled voters in November.
But even if the country has had a multiyear reprieve from IPAB and rationing, that could change. The government is on the hook to spend billions of dollars every year subsidizing health care coverage for those in the health insurance exchanges. All of the economic forces inherent in Obamacare will push premiums up, forcing the government to spend more tax dollars subsidizing policies. At which point the government would need IPAB to find ways to ration care.
Unless Republicans can kill the idea entirely, IPAB will live again.