Death Panels: A Defense of the Independent Payment Advisory Board
Death Panels: A Defense of the Independent Payment Advisory Board, 66 ADMIN. L. REV. 131 (2014)
41 Pages Posted: 26 Jan 2016
Date Written: March 1, 2014
Abstract
The Independent Payment Advisory Board (IPAB) has been vilified as a “death panel.” Despite these and other criticisms, the IPAB statute can and should be interpreted to make health care better, safer, and less wasteful for the United States healthcare system by focusing payment towards newly developed medical treatments that are most effective. The United States healthcare system seems to be riddled with waste. Unnecessary care is a serious moral problem, causing unnecessary suffering, and waste is an equally serious moral problem, leading to an indefensible scarcity of resources available to care for those who need it. The current incentive structure pushes medical advances towards the broadest possible market for the most expensive drugs, devices and medical services, with little regard for defining the narrow populations most likely to benefit. IPAB has the potential to countervail these current incentives, driving medical care towards a far better system, costing less and caring for people more effectively. This Article seeks to serve as a mission statement for the Board and a guide for future Congresses when assessing the Board’s performance pursuant to this standard of reducing waste. As of the writing of this Article, the Board is not yet formed, though it appears the Obama Administration is currently seeking to do so, and so its methods, focus and goals are still subject to theoretical debate. Currently, the debate appears to have been unnecessarily constricted by a set of false assumptions regarding the Board’s purpose, either a death panel or a mechanism for cutting physician reimbursement rates. Stepping back from the hyperbole regarding healthcare reform and, more specifically, IPAB itself, this Article frames the debate with an eye to what needs fixing, and how IPAB can help. First, it looks to the nature of the myriad problems and challenges within the healthcare system and suggests an interpretation of IPAB that can directly help resolve these. Next, it closely examines the language of the statute, analyzing its structure to see what it must and what it may do. It then presents a mission statement for IPAB, utilizing a positive and robust concept of the Board and its functions.
Keywords: Medicare, healthcare reform, health law, IPAB
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