Talking Back to David Rivkin and Elizabeth Foley on IPAB

David Rivkin and Elizabeth Foley have a vivid Op-Ed in the June 19, 2013 Wall Street Journal. Titled: "An ObamaCare Board Answerable to No One" the piece begins by singling out the Independent Payment Advisory Board (IPAB) as the ACA's "new beast, with god-like powers."  They then offer "a vivid illustration of the extent to which life-and-death medical decisons have already been usurped by governmennt bureaucrats" — the Sarah Murnaghan transplant case.

But, IPAB hasn't been formed yet. IPAB, even once formed, will have no individual utilization review decision power — the ACA leaves this power where it has vested for some time now, in the hands of commercial insurance company utilization review schemes. No such review exists for government funded insurance. What, then, could Rivkin and Foley be talking about when discussing Secretary Sebelius's decision to maintain two separate lung-transplant lists: one for children and one for adults? Will IPAB be in charge of the difficult decisions that must be made about organ transplant availability?

Organ transplant availability is a sorry mess in the United States, a morass of  easily-gamed conflicting lists, rules, and programs. You can learn more about the gaming of an overwhelmingly de-centralized system here: http://www.npr.org/blogs/money/2012/05/29/153914790/who-decides-whether-this-26-year-old-woman-gets-a-lung-transplant  Interestingly, it is not the government that has made it so chaotic.

Now, maybe you didn't know these things.  And maybe some of the readers of the Wall Street Journal didn't know these things.  But I am going to guess that David Rivkin and Elizabeth Foley could have found these things out with some research.  Maybe the Wall Street Journal's fact checkers could have helped them out.

But then the Op-Ed would have to have taken on IPAB's defects on its own terms.

 

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