Lately, the headlines out of Washington have focused a lot of attention on efforts by President Barack Obama and members of Congress to reduce spending and help solve the budget crisis our country is facing. The men and women that we have elected to represent us have been having problems agreeing on how to solve these problems, but the goal remains the same — to keep our country on firm financial footing. Sometimes, because the end goal can seem within reach, the path taken to reach that goal can have unintended consequences despite the best intentions of all involved.
Many believe one such case has happened with regard to Medicare. In an effort to reduce Medicare spending, the Independent Payment Advisory Board was created as a part of the Patient Protection and Affordable Care Act passed by Congress and signed last year by President Obama. The goal of the advisory board is simple and one that many can agree with on the surface of it: reduce and-or control Medicare spending. But it’s the path being taken to the finish line that creates concern.
The board’s role will begin in 2014. At that time, if Medicare costs are increasing faster than inflation, the board must recommend program changes to Congress by January 15 of each year to reduce spending. As the law is written, traditional hospitals are exempt from the board’s cost cutting for the first five years, leaving smaller, rural hospitals to likely feel the pain of the anticipated cuts.
Rural hospitals — like many of us — are already feeling the effects of a tough economy and are faced with tough financial choices every day. Cuts made by the board will make a difficult situation worse.
When rural hospitals are forced to make difficult decisions, it inevitably forces patients to make difficult decisions. Some of Maine’s most vulnerable citizens rely on Medicare in our rural, less-populated areas for — sometimes — very simple procedures. Cost-cutting decisions made by the board could include cuts in payments to doctors, which might result in doctors making the decision to not accept Medicare patients; or a decision that certain medications or procedures would not be covered by Medicare (see the July 20 letter to the editor, “Wrong Medicare Fix”, by Dr. Jack Forbush). When cost-cutting decisions are made without factoring in quality health care, the patient is the one who suffers.
The other troubling component of the board is the fact that it will have the power to make these cost-cutting decisions without much oversight and no means for individuals or doctors to challenge the decisions. As a result, it is highly likely that patients’ access to medical care will be limited in favor of efforts to control spending.
The members of the board will be appointed by the president, without being voted in by members of the public or having to answer to the public in any way. Additionally, any policy recommendations made by the board would be likely to go into effect, as the health care law makes it nearly impossible for Congress to override the decisions.
The decisions made by the board would not be able to be challenged once the cuts have been made. For Congress to put the level of quality health care for rural patients in the hands of 15 people who don’t have to answer to the constituents they are potentially hurting is downright irresponsible.
Health care needs and coverage varies from state to state. Health care reform is overdue. However, to have a board of individuals appointed by the president decide what is cost-effective for Medicare patients in rural Maine without regional vetting is not only concerning but dangerous.
We can agree that Medicare must continue to provide quality health care for its recipients while keeping spending in line, but the advisory board is not the answer. Either the Independent Payment Advisory Board portion of the health care reform act should be repealed or an appropriate oversight mechanism should be inserted in the process.
Ken Huhn is a longtime local health care administrator, public policy advocate and a former chair of the Bangor Region Chamber of Commerce.