“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Payment Advisory Board (IPAB), enacted as part of the 2010 Patient Protection and Affordable Care Act (PPACA) and repealed in February 2018 when President Donald Trump signed the Bipartisan Budget Act of 2018.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.”
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