Orthotics and Medicare

If there’s anything that shows the bipartisan idiocy and venality of the US Congress, surely it’s the objection to that Independent Medicare Advisory Panel.  Why have doctors and other medical professionals decide what treatments, medical devices, etc.,  it is worthwhile and costs effective to cover when you can have politicians do it?!

David and I had a nice visit with his orthodist (one trained in fitting custom orthotic devices– we’ve been going through a series of less instrusive devives to stretch out David’s tendons and get him off of walking on his toes  the latest are actually invisible in is shoes– hooray!).  Anyway, she had actually just been up in DC last week to lobby members of Congress about how Medicare covers orthotic and prosthetic devices.  We discussed some of the meetings she had.  Hey, more power to her for making her voice heard, but this is not how decisions should be made about how and how much Medicare covers.

One of the best parts of the ACA was the establishment of a Independent Payment Advisory Board to take on these issues free of political influence.  Sadly, member of Congress would rather just see Medicare costs rise unendingly and make their various constituents (though, not the American taxpayer) happy.  Who else but Ezra with the details:

It all goes to your theory of cost control in Medicare. In practice, I think liberals and conservatives both agree that Medicare’s problems have a lot to do with Congress’s inability to resist entreaties from the program’s users and suppliers. Conservatives think Medicare is constantly petitioned by seniors who want more lavish benefits, doctors who want higher reimbursements, device manufacturers who want their products included, etc. Liberals see it similarly, though with a more corporate spin: Medicare Part D doesn’t negotiate for low drug prices because drug companies persuaded legislators to stop Medicare from negotiating discounts on drugs…

What’s somewhat clearer is how IPAB solves this: You’d still have the traditional Medicare claimants running to their member of Congress to complain, but now he or she would be able to say, “there’s nothing I can do,” and, even better, “it’s not my fault.” IPAB’s recommendations can’t be amended and they can’t be filibustered, so individual members have vastly less control over the process than they traditionally have. All Congress can do is fully replace an IPAB recommendation with a reform that saves the same amount of money or muster both a supermajority and a presidential signature to stop IPAB from acting. Either path requires a lot more effort than undermining cost control does right now.

That’s (a) why IPAB is promising and (b) why a lot of members of Congress want to get rid of it and replace it with something that interest groups like better. In that way, the IPAB repeal effort is a useful way of sorting the legislators who want to control Medicare’s costs from those who want to preserve their power to keep Medicare’s costs from being controlled.

Chait takes down some of the ridiculous statements by Members of Congress trying to defend their largely indefensible position:

They don’t object to difficult decisions being “punted.” They object to difficult decisions being made at all. It’s not as if we haven’t tried letting Congress exert direct control over Medicare spending. We’ve had that system in place for 45 years. The answer is alwaysspend whatever you want.

If efforts to eliminate or completely defang the IPAB are successful, you can forget about us having any meaningful cost controls on health care spending for some time.  And that’s something that should concern every American.  Sadly, it doesn’t seem to concern much of our Congress.

About Steve Greene
Professor of Political Science at NC State http://faculty.chass.ncsu.edu/shgreene

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