New article looks at the rise and fall of Medicare’s Independent Payment Advisory Board

ddjhppl_42_3“Technocratic Dreams, Political Realities: The Rise and Demise of Medicare’s Independent Payment Advisory Board,” an article by Jonathan Oberlander and Steven B. Spivack in the Journal of Health Politics, Policy and Law (volume 43, issue 3), offers a groundbreaking, in-depth look at the troubled history of the Independent Payment Advisory Board (IPAB), enacted as part of the 2010 Patient Protection and Affordable Care Act (PPACA) and repealed in February 2018 when President Donald Trump signed the Bipartisan Budget Act of 2018.

This article addresses technocracy and healthcare through IPAB, a board of healthcare experts hailed for its innovation and designed to formulate Medicare policy recommendations based on evidence and reason rather than politics. Authors Oberlander and Spivack explore why Congress initially enacted IPAB, how we understand its broad appeal to the health policy community, and why IPAB failed to live up to its original hype and remained in political purgatory, paralyzed by controversy and partisanship.

Most health policy experts supported IPAB. The board was an ambitious way to combat the influence of interest groups and the health care industry on Medicare policy. It was also seen as an antidote to legislative inertia and Congress’s inability to manage Medicare. Experts, as well as some members of Congress, agreed that lawmakers could not make difficult decisions about Medicare and envisioned the board as an instrument of health services research and congressional self control. After the board’s establishment, industry groups attacked it, while many Republicans and some Democrats criticized IPAB and supported its repeal. Instead of realizing its aspirations, the board was mired in irrelevance. Prior to its repeal, IPAB existed as a shell under a presidential administration opposed to its existence.

“IPAB’s brief, troubled history offers a cautionary tale about the role of evidence, expertise, and independent panels in US health policy making,” Oberlander and Spivack write. “IPAB’s establishment reflected good intentions: to restructure Medicare governance so that program policy making was driven more by evidence and less by interest group pressures; to compel policy makers to consider and ultimately make difficult choices in Medicare reform; to prevent Congress from micromanaging and mismanaging Medicare; to ensure that, if Congress did not act, steps were still taken to restrain Medicare spending; and to create safeguards against excessive spending. Yet the aspirations to rationalize Medicare through IPAB have floundered against political realities.”

For more information regarding the Journal of Health Politics, Policy and Law, please visit dukeupress.edu/jhppl.

Read the full article here.

3 comments

  1. indeed these are very interesting as say prof dr mircea orasanu and prof horia orasanu in connection with following as JOURNAL

    Like

  2. in these cases we see and consider as say prof dr mircea orasanu that this JOURNAL is very indicated for news political specially in romania where appear thus frim questions

    Like

  3. also this journal being almost first formidable in mathematics and political as say prof dr mircea and prof horia orasanu we consider that followed appear
    CAVALIERI AND CLAPEYRON RELATION WITH LAGRANGIAN
    ABSTRACT Along a phase transition line, the pressure and temperature are not independent of each other, since the system is univariant, that is, only one intensive parameter can be varied independently.

    When the system is in a state of equilibrium, i.e., thermal, mechanical and chemical equilibrium, the temperature of the two phases has to be identical, the pressure of the two phases has to be equal and the chemical potential also should be the same in both the phases.

    Representing in terms of Gibbs free energy, the criterion of equilibrium is:

    at constant T and P

    or,

    Consider a system consisting of a liquid phase at state 1 and a vapour phase at state 1’ in a state of equilibrium. Let the temperature of the system is changed from T1 to T2 along the vaporization curve.

    For the phase transition for 1 to 1’:

    or
    or

    In reaching state 2 from state 1, the change in the Gibbs free energy of the liquid phase is given by:

    Similarly, the change in the Gibbs free energy of the vapour phase in reaching the state 2’ from state 1’ is given by:

    Therefore,

    Or

    Where the subscript sat implies that the derivative is along the saturation curve.

    The entropy change associated with the phase transition:

    Hence,

    Which is known as the Clapeyron equation

    Since is always positive during the phase transition, sat will be positive or negative depending upon whether the transition is accompanied by expansion ( >0) or contraction ( > )and hence = = =RT/P.

    The Clapeyron equation becomes:

    or

    which is known as the Clausius-Clapeyron equation.

    Assume that is constant over a small temperature range, the above equation can be integrated to get,

    or +constant

    Hence, a plot of lnP versus 1/T yields a straight line the slope of which is equal to –(hfg/R).

    Kirchoff Equation

    Kirchoff relation predicts the effect of temperature on the latent heat of phase transition.

    Consider the vaporization of a liquid at constant temperature and pressure as shown in figure. The late

    Like

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s