In particular, he addresses the many problems with the Independent Payment Advisory Board (IPAB):
Three features combine to make IPAB's regulatory power unprecedented: its decisions are largely uncontrollable by Congress, its actions are unreviewable by the courts, and -- amazingly -- the agency's existence is virtually unrepealable.One interesting point:
Ordinarily, the delegation of legislative power to regulatory agencies is accompanied by numerous safeguards. First, as a matter of separation of powers, courts require that the delegation of regulatory powers be guided and restricted by "intelligible standards." Second, most regulatory powers are exercised through the administrative rule-making process, which provides for public notice and comment. Third, both Congress and the courts can review the rules. Finally, of course, Congress can repeal the agency or change the delegation of power. None of those safeguards are present with IPAB...
The law says that certain proposals are off-limits, including any that "ration health care, raise revenues or increase Medicare beneficiary cost sharing (including deductibles, coinsurance, and copayments), or otherwise restrict benefits or modify eligibility requirements."(For more details, read the full text of "Obamacare's Other Unconstitutional Provision".)
[However,] crucial terms such as "rationing" are undefined, and the requirements are confusing and contradictory. Elsewhere, the law directs IPAB to "protect and improve Medicare beneficiaries’ access to necessary and evidence-based items and services." So IPAB is not allowed to ration health care, but it must decide which services are "necessary and evidence-based" -- which, of course, is rationing.
As financial pressures mount on Medicare, this de facto rationing will occur even if IPAB bureaucrats claim it's not rationing.
Fortunately, there's growing opposition from members of both political parties to this radical empowering of IPAB. Let's hope it's enough.