“Signs of ObamaCare’s failings mount daily, including soaring insurance costs, looming provider shortages and inadequate insurance exchanges.“
That’s the lead-in for a recent Wall Street Journal article about the Independent Payment Advisory Board (IPAB), written by David B. Rivkin Jr. and Elizabeth P. Foley. Regardless of how much factual information is presented in the remainder of the article, the authors show a strong bias against the ACA right from the get-go. The reader is warned from the start that ACA provisions will no doubt be disparaged in the article, and it makes one wonder how much of the article is factual and how much is spin.
It is an interesting article, as long as you read it with a clear understanding of the authors’ biases. It does seem a bit hyped and exaggerated in terms of the potential problems and power of the IPAB. After reading the WSJ article, one could start to imagine the IPAB as a bunch of Mussolinis 
sitting around a conference table, gleefully cutting payments to Medicare providers and hamstringing hospitals with higher-than-average costs. I wrote about the IPAB last fall, in a fact-checking post following the presidential debate in Denver. I don’t think it does our country (or our health care system) any favors to paint a picture of an uncontrolled, unaccountable bunch of government bureaucrats making decisions about medical care. Why not focus instead on how the IPAB could be successful in reforming Medicare so that we no longer do unnecessary (and potentially harmful) screening tests? There’s still debate over whether regional variation in Medicare spending is justified or not (the answer is probably somewhere in the middle), and that could be another place for the IPAB to focus their attention. There are many aspects of Medicare spending where the IPAB’s intervention is needed and justified. To vilify them before they even make their first proposals seems short-sighted.
The WSJ article begins with a reminder of the recent debate over regulations regarding lung transplants for children. The authors make the following rather curious statement:
“For a vivid illustration of the extent to which life-and-death medical decisions have already been usurped by government bureaucrats, consider the recent refusal by Health and Human Services Secretary Kathleen Sebelius to waive the rules barring access by 10-year old Sarah Murnaghan to the adult lung-transplant list.“
This is a bit of a head-scratcher. The rules regarding eligibility for donated organs are complex, and involve numerous factors including a patient’s health status and age. They’re created by people who are experts on transplant science, not government bureaucrats. They’re designed to try to ethically allocate a short supply of organs to the people who need them the most, and to the people for whom a transplant has the most chance of success (for example, a person who currently has cancer is not a candidate for a kidney transplant). There are different rules for different organs, and guidelines for both adults and children. Because demand for transplanted organs far exceeds supply, people die while waiting for organs (reminder: make sure your family knows that you want to be an organ donor, and push for legislative action that makes organ donation an opt-out system, as opposed to our current system that requires people to opt-in if they want to be donors). This is a sad reality – it will never seem “fair” to the families of people who die while on the waiting list for a transplant. And following the media debacle about Sarah Murnaghan’s case, the “Under 12” rule for lung transplants is being reviewed (hopefully by medical experts rather than judges, politicians, or journalists…)
But getting back to the point that the WSJ article authors made… it appears that in this case they wanted a government bureaucrat to interfere with the transplant rules that were created by people who are experts in transplant science (HHS Secretary Kathleen Sebelius has been a politician for her entire career and has no experience with transplant science). This PBS interview explains the reasoning behind the “under 12” rule, and while it’s obviously not individualized for every patient, it provides a scientific framework for allocating donor lungs where they will statistically have the best chance of success, based on medical criteria.
There aren’t enough lungs to go around for everyone who is waiting for one. Which means that the lung that was given to Sarah could have gone to someone else instead. What if that patient was 13 instead of 10? What if that patient’s family were to mount a media campaign the way Sarah’s family did? There are rules in place to regulate organ transplants, and they’re created by medical experts. But Rivkin and Foley seem to prefer that HHS Secretary Sebelius get involved and usurp the authority of the transplant experts who created the rules in the first place.
Given the nature of their article and their doom and gloom position about how the IPAB is going to function, this is a curious position to take. Do they want government bureaucrats to get involved in medical decisions or not? It appears that their viewpoint on this is muddy at best.
