Who Will Come to Own the Independent Physician Advisory Board?

From Kaiser News Network:

Sen. Jay Rockefeller (D-WV), who's one of the new board's biggest backers, says now, the biggest winners are inevitably those with the most effective lobbyists. (emphasis mine)

"The Congress often doesn't know how to say no and the Congress has a practice of never saying no, and so costs go up," he said at a recent Finance Committee hearing.

Rather, says Rockefeller, it would be better not only to insulate Congress from all those lobbyists, but to get people with more expertise on deciding how medical providers should be paid. "You want to have the Gail Wilenskys...and the Bruce Vladecks," he said, referring to former heads of the agency that runs Medicare. "People who have broad health care policy experience making those decisions."

But there's a problem. Both Wilensky and Vladeck – the former a Republican and the latter a Democrat — think the IPAB is a bad idea.

Wilensky, who oversaw Medicare for the first President Bush, says she's sympathetic to Congress's desire to insulate itself from the lobbying onslaught. But she worries that the board is limited to looking only at payments to health providers, which she says "could fundamentally alter the incentives involved in physicians and providers participating in Medicare."

In other words, it could end up driving Medicare payments so low that providers will simply leave the program, or else go bankrupt if they can't.

Vladeck, meanwhile, who headed Medicare under President Clinton, has a different problem with the board. He worries that eventually the lobbyists who are now so influential with members of Congress will become equally influential with the unelected members of the board.

"In the short term, it might theoretically work," he said. But the history with other independent regulatory agencies, like the Interstate Commerce Commission and the Civil Aeronautics Board is that over time "the regulated industries tend to capture them; and they tend to do more to protect the regulated industries than they do to protect consumers."

For the first time, we can finally put some potential names and backgrounds to individuals that might actually serve on the Independent Physician Advisory Board, according to those closest to the new Affordable Care Act.

As we can see, the individual names offered so far are people care removed from the front line of today's medical care and in many cases, are wed to the powerful interests that help control healthcare.

Bruce C. Vladeck is Senior Advisor to Nexera, Inc., a wholly owned consulting subsidiary of the Greater New York Hospital Association and worked as a Former Senior Health Policy Advisor/Co-Director, Academic Medical Centers, for the consulting firm Ernst & Young, LLP. He was a doctor long, long ago. Just not a physician. You see, according to one government source, "Vladeck received a bachelor's degree from Harvard University in 1970. He received a master's degree in 1972 and a Ph.D. in political science in 1973, both from the University of Michigan."

Gail Wilensky, Ph.D. works for project Hope developing and analyzing policies relating to health care and the economy; serves as a formal and informal advisor to government and the private sector, and writes and speaks about policies and politics of health care reform. She, too, is not a "physician."

These are names of the individuals that one of the principle proponents of the Independent Physician Advisory Board has offered as potential members of the Board: policy wonks.

Maybe this is another reason the Independent Physician Advisory Board is a bad idea: none of the members are likely to be physicians.

-Wes