A recent commentary by one of favorite bloggers,Dr. Robert Centor, spoke favorably about IPAB, one of many,many provisions of ACA.See here.I made a brief reply to his entry. I recalled my earlier blog entry and if Dr.Centror's comments stir up much furor I want to add this earlier blog post to the kerfuffle.Originally published 6/22/11 and now submitted with little editing:
I had been sketching out
some comments about what I was going to call "Platonic Medicine"
referring to the "leaders with ideas" who will lead the way to
transform medicine based on the underlying premise that "medicine is too
complex and important to be left to the individual physician and the
individual patient" and therefore it should be controlled and directed
by the wise medical elite who will determine the collective utility of a
given approach and its value.I have commented before about Don Berwick's advocacy of that view.
However, someone had written something in that regard better than I could.See here.
Hat tip to the Pacific Legal Foundation who filed a friend-of-the-court brief to challenge the constitutionality of IPAB on the grounds of violation of the non-delegation doctrine and for the above mentioned link which alerted me to Jost's frightening comments.
It turns out that an outspoken advocate and supporter of Obamacare,law professor, Timothy Jost has already praised that legislative act in part because of what the IPAB will provide. He said:
board of “Platonic Guardians” to govern the health care system or some
aspects of it. The cost of health care is spinning dangerously out of
traditional political institutions—Congress and the executive
administrative agencies—are too driven by special interest politics and
too limited in their expertise and vision to control costs. Enter the
Platonic guardians…an impartial, independent board of experts who could
make evidence-based policy determinations based purely on the basis of
effectiveness and perhaps efficiency.
is asserting that this board will be immune to the influence of special
interests and will make decisions rationally and in a proper evidence
based manner.From what planet will these board member be chosen?
Philosopher kings in charge,what could go wrong with that?
Consider the following: The federal government establishes a body, which is politically appointed and whose decisions will direct impact hundreds of milions of dollars of health care expenditure.Will it be likely or unlikely that interested parties,the usual suspects in the health care "system",will do everything they can to influence the composition and decision of that board.
commentary pointed out that a Platonic government was definitely not
what the founding fathers had in mind and Jefferson and associates were
not big fans of Plato.
In the commentary that I was
considering I thought perhaps calling the panel members Platonic
Guardians would earn me the accusation of being overly dramatic and
hyperbolic, but now we see an IPAB advocate using the same characterization and believing that to be a very good thing.
the coverage to control the cost for Medicare and Medicaid may not be
enough for the medical Platonic elite as is illustrated by this quote
from Dr. Robert Berenson:
"we ought to consider setting all payer-rates for providers." He continues "but the country's antigovernment mood renders such a discussion unlikely,at least for now".
I wonder who the "we" is that Berenson references.
Finally, another chilling quote from Mr. Jost:
the long run, Congress may not be able to cap Medicare expenditures
without addressing private expenditures as well. If the IPAB opens the door to rate setting for all payers,it may well be the most revolutionary innovation of the ACA".
Yeah, it just might be.