JONATHAN CHAIT JUNE 13, 2011
The strengthened Independent Payment Advisory Board is a crucial part of the Affordable Care Act, which has naturally given it a prominent place in right-wing demonology. One underlying problem is that Medicare pays for all sorts of procedures of dubious value. IPAB is a board of experts who use medical research to propose cost savings. There have been previous attempts to rationalize what Medicare pays for, but they are usually overridden because Congress tends to be beholden to the narrow interests of medical device-makers and other providers. IPAB circumvents this dynamic by making its proposals automatic, and they can only be overruled by a vote of Congress.
George F. Will considers this a massive affront to democracy:
Each proposal automatically becomes law unless Congress passes — with a three-fifths supermajority required in the Senate — a measure cutting medical spending as much as the IPAB proposal would.
Supermajority? Did somebody say supermajority? That's funny. Will, of course, is a fervent champion of the filibuster. He considers the filibuster near-divine, and wraps it in the language of the Founding Fathers, even though the Constitution only authorized supermajorities for ratifying treaties, endorsing constitutional amendments, overriding vetoes, expelling members and impeachment convictions.
I am not such a champion. I say that if you worry about the possibility that a senate minority will block a needed action, we should reform Senate procedures to limit or abolish filibusters. Will disagrees. Could a minority block needed reforms? No, says Will circa last year:
[H]as a filibuster ever prevented eventual enactment of anything significant that an American majority has desired, strongly and protractedly?
So what are you griping about? If IPAB makes any decisions that the great and good American people oppose strongly and protractedly, they will simply muster a House majority, 60 Senators, and a presidential signature to impose their will. Sure, that could take a decade a decade or three. But if we had to wait that long for civil rights legislation or universal health insurance or other measures long blocked by filibuster, I don't see why ineffective government-financed medical care should be on a faster track.