The Independent Payment Advisory Board (IPAB) is NICE

In March of 2010, then-Speaker of the House Nancy Pelosi famously said, "We have to pass the [health care] bill so that you can find out what is in it."  Subsequent study of this leviathan legislation has brought some truly startling revelations to light; however, the establishment of the Independent Payment Advisory Board (IPAB) will likely prove the most dangerous to our liberty.

IPAB is a fifteen-member board, appointed by the president and charged with developing recommendations regarding procedures, medications, and spending priorities for Medicare and Medicaid.  Ostensibly, the board members are to discover ways to implement the best practices, devising methods by which these programs may provide better services at lower costs.

To describe this board as a "death panel," as Rush Limbaugh has, is to underestimate its power and misconstrue its purpose.  While it is true that IPAB will decide which life-saving treatments and drugs Medicare and Medicaid recipients may access, its ultimate function will be to serve as a lever with which to pry the entire health care industry from private hands. 

In Britain's National Health Service, there exists an identical organ: the National Institute for Clinical Excellence (NICE).  (My previous articles on NICE can be found here and here.)  Because Britain is an entirely socialized medical system, NICE wields power over the health care options of all residents of Great Britain.  IPAB, initially, will make decisions regarding only the government-administered programs of Medicare and Medicaid.  This is simply a stepping-off point, however, as the White House Deputy Chief of Staff Nancy-Ann DeParle admits (italics mine):

Experts from the Commonwealth Fund wrote "the Affordable Care Act includes important provisions that will finally begin to control unchecked health care costs, such as...the creation of the Independent Payment Advisory Board. Building on and extending these provisions across the health system has the greatest promise of slowing the growth of government health care budget outlays, private insurance premiums, and underlying health care cost trends."

Interestingly though, the enacting legislation has been written in such a way as to preclude any meaningful attempts toward reform of costs by IPAB.

According to, "IPAB is specifically prohibited by law from recommending any policies that ration care, raise taxes, increase premiums or cost-sharing, restrict benefits or modify who is eligible for Medicare."

This inhibiting covenant is an attempt by the White House to preempt the arguments of Americans wary of government intrusion between themselves and their physicians.  The actual purpose, I believe, is to bar access to all cost-saving avenues, save the one sought by the Obama administration.  This is a failsafe mechanism written into the law that forces Congress out of the process.

Again from

Congress then has the power to accept or reject these recommendations. If Congress rejects the recommendations, and Medicare spending exceeds specific targets, Congress must either enact policies that achieve equivalent savings or let the Secretary of Health and Human Services follow IPAB's recommendations.

When Medicare and Medicaid costs threaten to burst through the statutory ceiling, triggering action by IPAB, Congress will be faced with a Hobson's choice.  IPAB can, and likely would, set the bar quite high for Congress by recommending huge cuts, using grossly inflated savings numbers, and making any equivalent cuts by Congress politically impossible to pass, resulting in certain inaction.  Remember, every member of IPAB will be an Obama nominee, beholden to an administration with a laughably poor track record of veracity regarding fiscal matters.  The pressure on IPAB to operate as a purely political instrument will be tremendous, if not irresistible.

Inaction on the part of Congress will effectively cede control to IPAB and HHS, leaving the administration unopposed in its effort to expand government control over the health care economy.  Should Congress summon the courage to actually pass cuts equivalent to IPAB recommendations, the political fallout would be devastating.  Either scenario plays to Obama's favor, and it is the purpose of IPAB to bring this about.

This is the Cloward-Piven strategy applied to health care.  The ObamaCare legislation is chock full of measures designed to swell the ranks (and costs) of Medicare and Medicaid.  The law creates entirely new classes of entitlements that not only will redound to the poor and elderly, but will inevitably co-opt the provider side of the industry as well.  Cloward and Piven postulated that by overwhelming the system, you can collapse the system, leaving the people clamoring for a ready replacement and gladly trading their freedoms for security. 

To understand IPAB and its intended role, it is essential to realize that ObamaCare isn't about health care, nor is IPAB about controlling costs.  Both are mechanisms for building dependent constituencies, hopefully sufficient to provide the left electoral success for decades to come.

IPAB plays the role of goading agitator -- pitting groups dependent upon government largesse against those citizens from whom the government derives its funds.  IPAB will demand, and Congress will reliably evade the tough decisions they were elected to make while bleating plaintively about their hands being tied by bureaucracy.

In Wisconsin we witnessed a grotesque belch of selfishness and entitlement on the part of public-sector unions.  Despite their outsized salaries and benefits, the unions raised such a hue and cry over the prospect of losing a fraction of their boon that much of America watched their preening indignation with a mixture of revulsion and dread.  How much more violent will the convulsions be when people are facing the prospect of medical rationing, the elimination of services for loved ones, and even death?  Rather than a circumstance to be avoided, Obama and his advisors intend to amplify this rage in order to cow any opposition as they amass unassailable power.

In Britain, one assessment used by NICE in their cost-benefit rationale is the concept of "social usefulness."  A necessarily subjective and entirely corrupt political calculation, social usefulness is nonetheless a significant factor in determining eligibility for life-saving or live-extending treatments in Britain.  NICE is absolutely a rationing board.  They don't deny it -- indeed, they celebrate their self-described "grown-up" treatment of the subject matter while simultaneously hiding behind the fig leaf of "citizen input" and "stakeholder consensus" when deciding who lives and who isn't worthy to draw another breath.

Dr. Donald Berwick, the recess-appointed head of the Centers for Medicare and Medicaid Services here in the United States, knows a thing or two about NICE.  He was its architect.  Berwick's think-tank, the Commonwealth Fund, is the leading apologist for single-payer health care in the United States and has long advocated installing our own version of NICE.  IPAB will operate as an arm of the Centers for Medicare and Medicaid Services.  Who better to direct and build a second Frankenstein's monster than Dr. Frankenstein himself?  We need only look to Britain to see the failed model the Obama administration has imported. 

The administration notoriously carved out special ObamaCare waivers for its friends and supporters.  Can there be any doubt that these same supporters will be judged "socially useful" when rationing comes fully to our health care system?  We will see Wisconsin ad infinitum once access to health care hinges on political patronage. 

The author writes from Omaha, NE and can be reached at
If you experience technical problems, please write to