The Infrastructure Of Health Care Deserves More Debate

To follow the media spin cycle in a presidential election can be enough to drive even the sanest person crazy, and given that I’m far from that, I generally keep it arm’s length. We’ve gone from last month, where it was said President Obama was an absolute shoo-in for re-election—in spite of the fact that average polling data amounted to little more than his lead moving two to four points.

Now, after Wednesday night’s debate, we’ve shifted into overdrive into declaring the Obama campaign dead and the Romney campaign roaring. Over the next couple days, as more polls come in, we’ll see how much of this translates into a real change in the landscape.

I didn’t watch Wednesday’s debate, opting instead for a trip to the Brewers-Padres baseball game in Milwaukee, near where I live. In retrospect, maybe it would have been more fun to watch Obama potentially cough up his lead than it was to watch the Brewer bullpen cough up their 6-0 lead, but after watching presidential debates since 1984 when I was a freshman in high school,  and my tolerance level for political spin has maxed out. But in reading the recaps, the candidates broached one topic that merits a more in-depth conversation, and it’s Independent Payment Advisory Board.

President Obama might not intend health care rationing, but the structure he put in place easily allows for just that.

You might recognize the Independent Payment Advisory Board (IPAB) as the “death panels”, that dominated the health care debate in the summer of 2009. Conservatives charged that the panels would ration health care and deny grandma the treatments she needed to stay alive for the sake of keeping within budget. Liberals furiously charged that this was a lie, that there were restrictions on what the IPAB could and couldn’t do.

Is it too bipartisan to say both bring a reasonable point? The IBPA has been granted the power to propose cuts in spending if health care dollars exceed a certain level, although Congress would have the option to come back with its own cuts. As a general rule, when Obama says he doesn’t intend that grandma be denied her health care, I’m inclined to believe him.

But what the president fails to grasp is that with the IPAB he has implemented a structure which can do just what his critics charge, regardless of original intent. And given the debate that goes on in the United States over end-of-life issues, is it really some huge stretch to suggest that a future panel might decide it’s best to save health care money by denying treatments to the elderly?

The fact the panel is unelected fits the needs of the cowardly politician perfectly. What better way to cop-out then by either claiming helplessness in stopping the evil IPAB, or even better, portraying themselves as outraged by the IPAB decisions.

And the mere existence of the IPAB is an example of why a market-driven approach to solving health care should be preferred. If you open up competition, put policies in place that allow people to own their own health coverage—as opposed to having it owned for them by their employer or the government, the competition for their business can produce more humane results. The government can then step in with Medicaid to pick up the slack where the market leaves off, rather than attempting to drive the whole process itself.

The IPAB is unlikely to have an impact on anyone’s life in the next few years, meaning it won’t get nearly the attention it deserves. But it is likely to have a major impact on everyone’s life 10-15 years from now. And if this sort of health care infrastructure is not what Americans want, the time to stop it is right now.

Dan Flaherty is the author of Fulcrum, an Irish Catholic novel set in postwar Boston with a traditional Democratic mayoral campaign at its heart, and he is the editor-in-chief of



  • Rich

    So the call for more debate is simply a cover to deny the fact that there is no death panel. There will be more debate and maybe this time people will finally pay attention and not just believe the rumors manufactured all around.
    Romney is already saying the part of ObamaCare that he likes enough to consider keeping, and Obama knows that the law (like many others) will undergo changes to the original until a program that works (for most) can be developed.
    There exists, and there is plenty of rationale for, oversight boards that are not elected in many of the governments programs. This should not be a surprise. Lots of Quasi-governmental organizations are charges will fulfilling the requirements or monitoring the regulations of many of our laws.
    To claim an unelected groups in health care is wrong and using the argument to return to market based insurance where an unelected group determines what can be spent when and on who is disingenuous.
    We also need to understand that the HHS Mandate can exist without ObamaCare, and that the Church is not against a more full health care program for the citizen of the US.
    Yes, I agree there needs to be a better debate on Health Care, maybe one limited to the truth would be a good start.

    • Joe M

      Obamacare includes an unelected board that will decide what treatments are allowed.

      That there could be a cutting edge treatment for a disease that someone has. But, it isn’t allowed by this unelected board is a real possibility. That isn’t the type of decision appropriate for government. Especially a board that is shielded from recourse by the electorate.

      • Rich

        OK Joe – you have been told and know that you are incorrect, and just seem to want to ignore the truth.
        What you are describing is closer to what your insurance company has right now to determine which treatments will eat up the profits and should not be allowed.
        If you just want to repeat you own false claims, then you are adding nothing to the conversation. Romney received not credit for saying this, as the most repeated comment was that his has been shown false so many times. He is aware that he is using the lie for his political advantage to keep the fear stirred up, but it is essentially irrelevant as it only sticks to those who want to believe it and are already opposed to ObamaCare.
        I am convinced that you do not believe your lie either.

  • FrankW

    These are the types of laws we get when we have a Congress (controlled by Democrats at the time) and a President who didn’t bother reading the bill before voting to pass it.. Of course, it stands to reason that any bill 2,700 pages would be considered too long to read by just about any rational person.
    The fact that Congress exempted itself from this law, and speaker Pelosi famously quipped that “we have to pass this bill to find out what’s in it”, should tell us all we need to know about Obamacare. It’s not good enough for them, but we’re supposed to swallow it up with no questions asked.
    The sad truth about this law is that its purpose is apparently not about extending health insurance to those who do not have it. If that had been the purpose, this law would have been a much less complex expansion of Medicaid. Instead, this law contains incentives for employers to drop their insurance, and send their employees to the government. Secretary Sebelius has publicly stated that the days of private health insurance are numbered, and it will be extinct within a few years.
    So yes, this subject does deserve more debate than it got when Congress crammed this through with zero Senate GOP votes, and one GOP House vote. When some publicy railed against the IPAB, calling it the death panel, these people were ridiculed. Now we find out that while our President keeps telling us that he doesn’t want our insurance company coming between us and our doctor, he has no problem what so ever with the government (IPAB) coming between us and our doctor.

  • Connie

    Did you forget that the majority of American’s didn’t want this healthcare law? Yet it was crammed down our throats anyway. Apparently the only time the American people’s opinion matters is when they want to be re-elected. They haven’t even read it, and they passed it anyway. They will just make it up as they go along. People need to do their own homework and stop listening to the main stream media’s propaganda.

    • Let Peeps Vote

      actually, when you explain that the healthcare law insures that more Americans have insurance, that others don’t get stuck paying for the bills of the uninsured, that pre-existing conditions are no longer an impediment for getting insurance, and that the bill requires that the insurance company return excessive profits to the people that paid for the insurance, then Americans generally agree with the law. What Americans don’t agree with are the lies that people spew about this law in order to damage the President’s reputation.

      • Joe M

        That’s like saying that people would like to have a Ferrari if they get it for free.

        When Americans consider the entire Obamacare bill, costs vs. benefits, the majority of them do not want it. Never did.

  • Randall

    Step 1) Repeal Obamacare in its entirety. Step 2) End Medicare and Medicaid, the second and third largest boondoggles in the history of the country (SS being the first). Step 3) Let the free market sort it out. Your’e welcome.

    • Let Peeps Vote

      My son has insurance again and can go to the doctor again because of this law. You want to repeal it?

  • Let Peeps Vote

    We’ve been debating healthcare for decades. Under Clinton, we debated healthcare, under Bush we debated healthcare. While we continued to debate healthcare (and do nothing), costs continued to rise, people were denied coverage, and our ER’s became overrun with uninsured people seeking basic care without being able to pay for these services. In 2009 we finally did something about it and took a step forward. The Affordable Healthcare Law may not be perfect, but it insures that more people are covered, that existing conditions don’t exclude Americans from getting insurance, and has allowed young people to remain on their parent’s plans until they begin their own careers.

    Unfortunately, people like you are willing to gut all the good things that this law does for millions of Americans because you don’t like the President. Further, during the entire healthcare debate, Republicans didn’t offer ONE SINGLE ALTERNATIVE PLAN and have STILL REFUSED TO OFFER AN ALTERNATIVE PLAN. If you have something better, let’s hear it, but complaining about the law while you offer no alternatives is just moronic.

    • Randall

      Well you’ve finally (though probably unintentionally) hit on a good partial solution. Ban all uninsured from receiving ER care. Most of them are illegal immigrants, drug chasers, and people who live high on the hog off of welfare but don’t want to actually spend their money. Obamacare has only vindicated the undeserving idiots who view the ER as a free all-you-can-eat drug and medical care buffet, and now they’re going to crash the system even harder. Under the pay-first system, a few genuine poors might slip through the cracks, but after a few years the uninsured problem will solve itself. Insurance or payment in full before you’re even allowed to set foot in the hospital. Try to get free care and it’s prison time, pal.

      • Romobamacare

        So, you disagree with Romney’s kinder new position (as of yesterday). But the new position is the old Romneycare solution which was the basis of Obamacare. So why are you voting for such a liberal? Are you expecting him to flip-flop again into a true conservative if he gets elected?

      • Jesus Himself

        Because denying healthcare for people because they don’t have enough gold coins to pay you is something Jesus would teach?

        • Joe M

          Nobody has proposed denying healthcare as a solution. Keep believing that kool-aid and liberals will keep being unprepared for the actual arguments conservatives are making.

    • Joe M

      Let Peeps Vote. What you argue in this comment was already brilliantly rebuked by Romney in the debate. A Republican, Mitt Romney himself, HAS offered an alternative that addresses the issues you list and removes the issues that are wrong with Obamacare (and are unpopular with the people).

      The belief that Republicans didn’t offer ideas or alternative plans is kool-aid. Obama drank it and found himself caught off guard in the debate. But, go ahead and keep feeding into the kool-aid machine. Maybe it will again help liberals be unprepared for the actual arguments their opponents are making.



Receive our updates via email.