Medical Decisions Should be Made by Patients and their Doctors — Not the Government

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By Dr. Gary Pushkin and Dr. Anuradha D. Reddy

As physicians, we understand that every patient is different, and every case must be treated as unique. There are no one-size-fits-all solutions when it comes to medical care — and the same is true for health care policy. That’s why patients and their doctors, not the federal government, should be able decide what treatment options are right for them.

However, unless the House of Representatives takes action this week to repeal a controversial provision of health care reform, a panel of unelected, unaccountable bureaucrats in Washington will soon have the power to make sweeping cuts to Medicare that could restrict access to necessary treatments and medications for millions of seniors.

This panel, the Independent Payment Advisory Board (IPAB), was established by the Affordable Care Act and charged with cutting Medicare costs. Starting in 2014, the 15-member panel will have the authority to make strict cuts in services to Medicare patients and payments to doctors and providers based on arbitrary annual spending targets.

IPAB’s decisions could limit seniors’ choices of necessary treatments and medications and restrict access to life-saving care. Harsh cuts in payments could also force some health care providers to stop taking Medicare patients entirely, further limiting choices for seniors and lowering quality of care.

To make matters worse, the panel will effectively operate behind closed doors and will be subject to little or no oversight. Seniors will not be able to question or appeal the board’s recommendations, and even Congress will have little recourse to challenge its decisions.

While it is imperative that we get Medicare spending under control, IPAB is a blunt and short-sighted solution that will likely only make matters worse. Due to its narrow focus on short-term costs and arbitrary annual targets, IPAB could make cuts that actually hinder the kind of medical innovation that will reduce Medicaid costs — and health care spending across the board — in the long run.

Consider, for example, a new treatment that could delay the onset of Alzheimer’s disease. Such a discovery would likely increase costs at first, but significantly reduce spending down the line on institutional care and other needs. Yet IPAB’s mandatory annual spending targets wouldn’t take this into account, and the board likely wouldn’t cover such treatments — stifling research and development

Similarly, advances in health information technology (health IT) can help to improve patient care and ultimately reduce costs by making the health care system more efficient. However, health IT requires an up-front investment, and could face cuts from IPAB as well.

If we are serious about controlling the long-term growth of health care costs in America, we need to focus on improving the quality of care with a results-driven approach that emphasizes prevention, rather than simply slashing Medicare payments and coverage.

While we support some of the goals of the Affordable Care Act, IPAB is a misguided provision that will take decisions out of the hands of patients and their doctors, threaten seniors’ access to medical care, and hinder the development of new treatments and cures that can reduce costs in the long term.

We strongly urge members of Maryland’s Congressional Delegation to stand with patients and health care providers by voting to repeal the Independent Payment Advisory Board when the House of Representatives takes up the measure this week.



Gary Pushkin, M.D. is an orthopedic surgeon and the Past President of the Baltimore County Medical Society; Anuradha D. Reddy, M.D. is a rheumatologist and the Past President of the Baltimore City Medical Society.
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