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Thread: House Votes to Repeal Obamacare Provision

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    Unencrypted Wraith's Avatar
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    Default House Votes to Repeal Obamacare Provision

    House votes to repeal key 'Obamacare' provision

    By Tom Curry, msnbc.com National Affairs Writer

    The House voted Thursday to repeal a central provision of the 2010 health care overhaul, the Independent Payment Advisory Board (IPAB).

    The vote was 223 to 181, with seven Democrats voting with most Republicans to abolish IPAB. Ten Republicans voted against the effort to kill IPAB.

    The board’s job is to propose cost-saving changes to Medicare if per capita spending on that program exceeds a target, the national income growth rate, plus 1 percent. The IPAB changes would automatically take effect unless Congress blocked them or enacted its own cost-saving measures.

    The House vote took place only four days before the Supreme Court begins hearing oral arguments on the constitutionality of other provision of the 2010 law.

    Thursday’s vote will have little more than a symbolic election-year effect since if the Senate were to vote on IPAB, Democrats have enough votes to keep it alive.

    And the board, which is supposed to have 15 members with expertise in medical care and economics, still exists only on paper: President Obama has not yet nominated anyone to serve on it. Its members are subject to Senate confirmation.

    But the White House has issued a veto threat against the House bill, saying it would dismantle IPAB “even before it has a chance to work. The bill would eliminate an important safeguard that… will help reduce the rate of Medicare cost growth responsibly while protecting Medicare beneficiaries….”

    The 2010 Affordable Care Act which created the board, says IPAB can’t ration care, restrict benefits, increase the premiums Medicare recipients must pay, or alter the eligibility for Medicare. But it can limit or change payments to doctors, hospitals, hospices, and other providers.

    After the vote, the chief proponent of IPAB, Sen. Jay Rockefeller, D- W.V., issued a statement denouncing the move to abolish it.

    “Today’s House vote is a good example of what happens when special interests win – seniors lose,” he said. “The Independent Payment Advisory Board was created to protect Medicare for seniors – by improving the quality of Medicare services and by extending the life of Medicare for years to come."

    In House debate Wednesday, Rep. Sander Levin, D- Mich., defended IPAB, saying, “For conservatives who talk about the importance of cost containment, they want to repeal an act that has within it not only the seeds of cost containment, but the instrumentalities of it. In fact, they’re beginning to work well enough. That’s why CBO (Congressional Budget Office) says that it’s going to be 10 years before IPAB is triggered.”

    But Rep. Dan Lungren, R- Calif., said, “The idea that 15 unelected individuals on the Independent Payment Advisory Board have been empowered by the so-called Patient Protection and Affordable Care Act to ration health care for seniors—and that’s for all seniors— is as Orwellian as these titles crafted by the previous Congress to divert attention from what’s really being done here.”

    He said that IPAB “raises the most serious ethical concerns about respect for the dignity of our seniors. This is the unfortunate consequence of a world view which favors the notion of bureaucratic expertise and efficiency as a solution to the challenges facing our health care system today.”

    The House bill also included a provision to impose a $250,000 cap on noneconomic damages and to limit the contingency fees lawyers can charge in medical malpractice cases.
    Source

    Okay, I don't get it. This doesn't seem like a terrible part of the bill. In fact, it seems like something that the Republicans should be alright with. What's the problem here? Is this really just politics, and Obama getting to make all the appointments? Is there some other deep flaw with the IPAB?

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    Nihilist Nessus's Avatar
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    I'm sorry, have you not seen a Pubbie since the election '08? This is kind of what they do now
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    Senior Member GGT's Avatar
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    "IPAB would be akin to the idea of the Base Realignment and Closure Commission. Past BRAC panels have been successful in eradicating redundant military bases."

    IMO it's a mistake to compare military spending with healthcare spending. Not just because they're different public-serving entities, but because legislators can't even agree on the role of government in healthcare at all:

    When Congress tries to control Medicare spending, Rockefeller complained in 2009, there are “too many lobbyists involved and it's very, very difficult if you have a lobbyist that comes in … who represents an industry in your state which could gain an enormous advantage by having an increase in the reimbursement rates for Medicare , for oxygen or for something else.”


    Rather than members of Congress deciding what Medicare will pay for, Rockefeller said, “These are decisions that should be made by professionals, people who are public policy professionals. They're not lobbyists. And they're not necessarily sitting with congressmen or senators.”


    Uwe Reinhardt, a health care economist at Princeton University and an IPAB supporter, said Congress “micro-manages in the most amazing way” in deciding how Medicare operates.

    And yet, he said, members of Congress are “beset by incredible conflicts of interest. With Congress, you really always have to worry: Whom do they represent: the people, or particular interest groups that give them money?” Companies that sell services to Medicare also contribute to congressional campaigns, he noted.
    Sounds like an argument for a US version of a NHS, single-payer, Medicare for all, or a public option---or any combo hybrid that would get us into the top tiers of providing excellence and quality of care---instead of just being big spenders on a crappy system.

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    SEÑOR Member Aimless's Avatar
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    Well many of them seem to have been opposed to comparative effectiveness research as well, so who knows what's going on in those heads. I'm not sure how IPAB would be unethical or violate the dignity of seniors. Is it more unethical and less dignified than eg. scrapping all government-sponsored healthcare because of its unsustainability? Or just taking more money from the whole population, to pay irresponsible healthcare providers?

    I reckon they're just being tactical.
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    All Worship Ragnarök Loki's Avatar
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    Quote Originally Posted by GGT View Post
    Sounds like an argument for a US version of a NHS, single-payer, Medicare for all, or a public option---or any combo hybrid that would get us into the top tiers of providing excellence and quality of care---instead of just being big spenders on a crappy system.
    I know logic isn't your strong point, but if the current problem is that the government has too much influence over what happens in the healthcare industry, how the hell does giving the government total control going to improve things?

    Quote Originally Posted by Aimless View Post
    Well many of them seem to have been opposed to comparative effectiveness research as well, so who knows what's going on in those heads. I'm not sure how IPAB would be unethical or violate the dignity of seniors. Is it more unethical and less dignified than eg. scrapping all government-sponsored healthcare because of its unsustainability? Or just taking more money from the whole population, to pay irresponsible healthcare providers?

    I reckon they're just being tactical.
    The GOP is against having the government negotiated down prices because they're against unnecessary coercion against the private sector.
    Hope is the denial of reality

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    SEÑOR Member Aimless's Avatar
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    Because there's a direct and linear relationship there yeah. Consequences partial crappy useless control are necessarily representative of consequences of total control.
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    All Worship Ragnarök Loki's Avatar
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    Quote Originally Posted by Aimless View Post
    Because there's a direct and linear relationship there yeah. Consequences partial crappy useless control are necessarily representative of consequences of total control.
    GGT's problem is that lobbyists are able to pervert the process because of the influence they have over politicians. Presumably their influence over politicians won't decrease if we get our version of the NHS, while the range of areas over which they'll have influence will increase. If she doesn't trust politicians to pursue the interests of the public right now, why would she possibly assume the politicians will magically change their actions afterward?
    Hope is the denial of reality

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    Senior Member RandBlade's Avatar
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    If this is so important, then why have there not been appointments yet 2 years after it was passed into law? While the same party controls both the White House and the Senate?

    It seems to me that Obama has already abolished it "even before it has a chance to work" by not making those appointments.
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    De Oppresso Liber CitizenCain's Avatar
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    Quote Originally Posted by Senator douchebag
    “Today’s House vote is a good example of what happens when special interests win – seniors lose,”
    Because seniors aren't a special interest group at all, you stupid cunt.

    Whadda douche.

    Quote Originally Posted by Wraith View Post
    Is there some other deep flaw with the IPAB?
    Unelected bureaucrats being charged with total control over a major sector of the economy isn't flawed enough for you? How's that working out with the FCC, by the way? (And of course, the FCC doesn't even get to fix pricing for advertising and broadcasting and media and such.)

    Quote Originally Posted by Loki View Post
    The GOP is against having the government negotiated down prices because they're against unnecessary coercion against the private sector.
    There's that, but Minxy is also right about it being a tactical move. (Both in the sense of election year political tactics and in the sense of the real target being Obamacare, and the strategy being to take it out one piece at a time.)
    "I predict future happiness for Americans if they can prevent the government from wasting the labors of the people under the pretense of taking care of them."

    "The tree of liberty must be refreshed from time to time with the blood of patriots and tyrants."

    -- Thomas Jefferson: American Founding Father, clairvoyant and seditious traitor.

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    All Worship Ragnarök Loki's Avatar
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    They've been doing this for years though.
    Hope is the denial of reality

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    De Oppresso Liber CitizenCain's Avatar
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    Yes. That impacts what I said... how?
    "I predict future happiness for Americans if they can prevent the government from wasting the labors of the people under the pretense of taking care of them."

    "The tree of liberty must be refreshed from time to time with the blood of patriots and tyrants."

    -- Thomas Jefferson: American Founding Father, clairvoyant and seditious traitor.

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    All Worship Ragnarök Loki's Avatar
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    It's not really a tactical move when it's consistent with their pre-election campaign policies. This isn't really the part of Obama's healthcare that the public has problems with anyway; it's much better to focus on the mandate to buy insurance.
    Hope is the denial of reality

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    De Oppresso Liber CitizenCain's Avatar
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    So, it's not a tactical move because it's consistent with their election year tactics. Alrighty then.
    "I predict future happiness for Americans if they can prevent the government from wasting the labors of the people under the pretense of taking care of them."

    "The tree of liberty must be refreshed from time to time with the blood of patriots and tyrants."

    -- Thomas Jefferson: American Founding Father, clairvoyant and seditious traitor.

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    SEÑOR Member Aimless's Avatar
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    Quote Originally Posted by RandBlade View Post
    If this is so important, then why have there not been appointments yet 2 years after it was passed into law? While the same party controls both the White House and the Senate?

    It seems to me that Obama has already abolished it "even before it has a chance to work" by not making those appointments.
    Could be because this advisory panel isn't supposed to kick into action until 2015.

    If politicians don't like the specific proposals the board comes up with it's up to them to present their own proposals for reining in medicare spending and vote it through, as long as that proposal cuts spending by approximately the same amount. Or so i gather
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    Administrator Dreadnaught's Avatar
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    Quote Originally Posted by Wraith View Post
    Source

    Okay, I don't get it. This doesn't seem like a terrible part of the bill. In fact, it seems like something that the Republicans should be alright with. What's the problem here? Is this really just politics, and Obama getting to make all the appointments? Is there some other deep flaw with the IPAB?
    It's pretty foundational to the worst fears about Obamacare. IPAB is the "death panel" by another means.

    If they decide that a particular treatment is "bad" or "too expensive" in some way or another, they will fundamentally change the compensation for that treatment. Or they will prioritize their own preference. This will either make the treatment more expensive for non-seniors or eliminate the treatment altogether.

    Obviously one can have a long discussion about the merits of this kind of approach, but it's basically a club of judges who decide what Medicare should/should not cover. I actually wouldn't mind this approach if most of the other problems in the private health insurance market were fixed. Primarily because private medical insurance would be cheaper and this panel would find itself having to gut most of Medicare, thus exposing what a fiscal farce it is.

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    SEÑOR Member Aimless's Avatar
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    except that if congress doesn't like ipab's proposal it can make its own proposal
    “Humanity's greatest advances are not in its discoveries, but in how those discoveries are applied to reduce inequity.”
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    Senior Member GGT's Avatar
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    Quote Originally Posted by Loki View Post
    I know logic isn't your strong point, but if the current problem is that the government has too much influence over what happens in the healthcare industry, how the hell does giving the government total control going to improve things?

    The GOP is against having the government negotiated down prices because they're against unnecessary coercion against the private sector.
    Quote Originally Posted by Loki View Post
    GGT's problem is that lobbyists are able to pervert the process because of the influence they have over politicians. Presumably their influence over politicians won't decrease if we get our version of the NHS, while the range of areas over which they'll have influence will increase. If she doesn't trust politicians to pursue the interests of the public right now, why would she possibly assume the politicians will magically change their actions afterward?
    I reject your "diagnosis" (of what I posted, and what the "problems" are). The US has a horrible history of cost-containment for healthcare, by both private and public insurance. The current problem is that health care is unaffordable without a subsidy of some sort. We tried tying it to employment, with employers 'subsidizing' private premiums. We tried coupling it with payroll taxes, with public funds 'subsidizing' public premiums. Neither have worked.

    The US ranks low on healthcare in all sorts of areas....whether it's numbers of insured, numbers without access to basic services, costs per patient, or value per dollar, etc. We have people showing up (by the thousands) in sports arenas just to get physical exams, and basic care. Funds for Medicaid, Medicare, Planned Parenthood, and SCHIP are being slashed at state levels. Hell, it's even become contentious to fund sex-ed in public schools, as part of frickin' Biology!


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    Senior Member GGT's Avatar
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    Quote Originally Posted by Aimless View Post
    except that if congress doesn't like ipab's proposal it can make its own proposal
    A good point. Congress legislators have powers in our representative democracy/republic. Many might say state control trumps all, but that ignores the importance of our Union. We're supposed to be a United States of America. Not just 50 states and a few territories acting as totally independent entities.

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    Quote Originally Posted by Dreadnaught View Post
    It's pretty foundational to the worst fears about Obamacare. IPAB is the "death panel" by another means.
    And what do we have now? Wealth decides health?
    .

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    Senior Member GGT's Avatar
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    What we have now is a healthcare system dominated by employers and the insurance industry, protected by legislators. That's not really healthcare, but crony corporatism.

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    Senior Member RandBlade's Avatar
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    Legislators are the problem, so lets give more power to legislators?
    Quote Originally Posted by Ominous Gamer View Post
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    De Oppresso Liber CitizenCain's Avatar
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    Quote Originally Posted by RandBlade View Post
    Legislators are the problem, so lets give more power to legislators?
    The battle cry of the lefties, yeah.
    "I predict future happiness for Americans if they can prevent the government from wasting the labors of the people under the pretense of taking care of them."

    "The tree of liberty must be refreshed from time to time with the blood of patriots and tyrants."

    -- Thomas Jefferson: American Founding Father, clairvoyant and seditious traitor.

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    Administrator Dreadnaught's Avatar
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    Quote Originally Posted by Aimless View Post
    except that if congress doesn't like ipab's proposal it can make its own proposal
    The problem is they are setting a very high standard for our legislature to revoke a proposal. They will basically need two separate majority votes plus the President's signature to appeal what this panel dictates.

    Sure, big things could lead to controversies. But the panel's decisions are basically untouchable.

    Quote Originally Posted by Being View Post
    And what do we have now? Wealth decides health?
    We have a broken health insurance market. That's why we need comprehensive health care reform. Which is completely opposite of what we got in 2010.

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    SEÑOR Member Aimless's Avatar
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    Quote Originally Posted by Dreadnaught View Post
    The problem is they are setting a very high standard for our legislature to revoke a proposal. They will basically need two separate majority votes plus the President's signature to appeal what this panel dictates.
    Why is that, specifically, a problem?
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    Administrator Dreadnaught's Avatar
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    Because it's sort of the worst of both worlds -- it's a mostly-unaccountable board that will be making huge and (as far as I know) unappealable healthcare decisions. New treatments or procedures could be sidelined simply because this board doesn't like them.

    At the same time, the one avenue of accountability (action by our legislatures) almost guarantees that the few issues which do result in Congressional overruling will be really stupid. EG when they find out that abortion drugs also help older women deal with menopause, the Christian Right will lobby to have the drugs nixed anyway. And then we'll have a stupid fight over it.

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    Stingy DM Veldan Rath's Avatar
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    Quote Originally Posted by Aimless View Post
    Why is that, specifically, a problem?
    Because we (read the political hacks we elect) politicize EVERYTHING, (see Terry Schivo and the poor kid the got shot fiasco now) so getting majorities from BOTH houses AND getting the POTUS to sign on is f-ing laughable at best.
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  27. #27
    Senior Member GGT's Avatar
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    Quote Originally Posted by RandBlade View Post
    Legislators are the problem, so lets give more power to legislators?
    We are a nation of laws. We are a United States that fights over federal vs state laws, and jurisdiction, and ultimately agrees to the breadth and scope of our Supreme Court, with their interpretations of the US Constitution and legal precedence. This case falls under the Commerce Clause, something "congress" (legislators) have routinely complied with and even encouraged. Our legislative branch is tied to our judicial branch, by purpose, because we are a Union. Not just a bunch of disconnected states acting independently.

  28. #28
    SEÑOR Member Aimless's Avatar
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    Quote Originally Posted by Veldan Rath View Post
    Because we (read the political hacks we elect) politicize EVERYTHING, (see Terry Schivo and the poor kid the got shot fiasco now) so getting majorities from BOTH houses AND getting the POTUS to sign on is f-ing laughable at best.
    Great, then it'll be more difficult for that sort of politics to influence medicine. There're data from decades of thorough research into medicare to help guide the board in making recommendations for how to rein in costs. Everyone's yelling about death panels and blocking miracle-cures, as if those are the only conceivable solutions to the problem of increasing medicare costs.
    “Humanity's greatest advances are not in its discoveries, but in how those discoveries are applied to reduce inequity.”
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  29. #29
    Stingy DM Veldan Rath's Avatar
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    Quote Originally Posted by GGT View Post
    We are a nation of laws. We are a United States that fights over federal vs state laws, and jurisdiction, and ultimately agrees to the breadth and scope of our Supreme Court, with their interpretations of the US Constitution and legal precedence. This case falls under the Commerce Clause, something "congress" (legislators) have routinely abused and willfully misinterpreted. Our legislative branch is tied to our judicial branch, by purpose, because we are a Union. Not just a bunch of disconnected states acting independently.
    Fixed.
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  30. #30
    Senior Member GGT's Avatar
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    Veldan, how would you have changed the Commerce Clause to make the ends meet your goals? An Amendment to the Constitution?

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