Following eight years of Obama, it will take some doing for Republicans in Washington to learn how to most effectively wield the power they just won in the election. The results of Republicans’ control of Congress were certainly not stellar, but they were limited by Obama. Now there are no excuses: they must make significant gains.
For replacing the president’s health care law, that means walking before you run. Full repeal of Obamacare absolutely must be achieved, but for a variety of reasons the path will be more arduous than you might expect.
Democrats retain the capacity to filibuster, so Republicans plan to use the Senate’s “reconciliation” procedures to repeal the dreaded health care law with only a bare majority.
Reconciliation is complex and must be handled with care. Rushing would be a mistake: Democrats will be looking to trip up the effort by any means available, so no mistakes can be allowed.
On the other hand, it’s imperative for Republicans to come out of the gate with some early victories to build momentum for their consequential moves.
Clearly, the wisest course of action is to begin with some of Obamacare’s least popular parts. And what better place to start than the law’s infamous “death panels,” the “Independent Payment Advisory Board” (IPAB)?
IPAB is one of the law’s most notorious provisions not only because it rations health care, but because it rations health care at the beck and call of unelected bureaucrats intentionally insulated from any accountability whatsoever.
Like several legislative booby traps in Obamacare, IPAB is granted authority in the law to change the law. Its recommendations automatically go into effect unless Congress votes to disapprove under almost comically restrictive rules.
The members of this rarefied board of rationers do not serve at the pleasure of the president, or anyone else. They may only be removed “for neglect of duty or malfeasance in office, but for no other cause,” the law says.
It’s reminiscent of the way the Constitution envisions the judicial branch, except judges are granted independence to interpret the law. In the Constitution, the people who write the laws are supposed to be accountable to the people.
The only reason anyone would create a legislative contraption like this is to insulate the board’s decisions from public scrutiny. And the only reason to insulate its decisions from scrutiny is because they’ll be unpopular.
Just what are they planning to do with this power? IPAB was studiously designed to avoid the idea that its purpose is to ration health care, but its flimsy restrictions only serve to prove the point.
For example, Obamacare says IPAB “shall not…ration health care.” But the law fails to define “ration,” meaning even a first-year law student could shoot that down in about ten minutes.
The principle that drives IPAB’s design is the same idea behind all price controls: “we’ll make it cost less by paying less money for it.” Hence all of the board’s decisions are channeled into payment “reforms.”
But the scary part is the effort in the law to insulate IPAB from accountability. Obamacare actually tries to prevent future congresses from altering IPAB, saying literally that any such bill will “not be in order” to consider on the House or Senate floor.
Its recommendations are also given immunity from judicial review.
No other government entity has ever been given this kind of wide ranging authority and immunity from accountability. Beyond rationing, this is a precedent that could undermine the very nature of our democratic system.
Obamacare, all of it, must go. But some parts are worse than others. IPAB is arguably the worst provision in the entire law. It makes sense to use it as an early, easy victory to build momentum on the path to full repeal.