IPAB Wields Chainsaw for Want of a Scalpel

But the restrictions on its power mean it won't be the benevolent dictator many wish for in healthcare. Instead, it will be forced to use the blunt tool of rate cuts, where a more nuanced approach might be the better solution. Of course, that would mean granting the board more power.

President Obama, in his latest attempt at a grand legislative bargain on deficit reduction, has recommended that IPAB be given broader authority to make its decisions—and at a lower budgetary threshold of 0.5% growth over GDP.

The Board would also be allowed to consider other, more surgical interventions to curb cost growth that would focus on value-based benefit design—something the current version of IPAB is unable to do. But it's tough to see Congress agreeing to the President's recommendations concerning IPAB, because even though it does not yet exist, IPAB has made powerful enemies.

Almost, if not all, Republicans, never wanted the board in the first place. Neither are many Democrats enthused, fearing that IPAB could limit access to medical care if reimbursements are cut to a level that would cause some providers to stop seeing Medicare patients.

What legislators ignore is that some group is going to have to take responsibility for making tough decisions on healthcare costs. Congress has already proved itself incapable. Should all the work be done by one group?

Possibly. If so, and if IPAB is that group, one of its biggest problems is not that it has too much authority, but rather that it does not have enough.

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