Everyone agrees Medicare spending growth is unsustainable, but the specifics of how to curb it are much tougher to agree on. The health-care overhaul law charges a panel — called the Independent Payment Advisory Board, or IPAB — with making recommendations for cuts in some cases. As Kaiser Health News reports , starting in 2015, if per-beneficiary spending is projected to rise by more than the average of general consumer and medical inflation, the 15-member board can issue its own binding recommendations. (Starting in 2020, the threshold growth rate will be GDP growth plus one percentage point.) KHN continues: Those recommendations will be sent to Capitol Hill at the beginning of the year, and if Congress doesn’t like them, it must pass alternative cuts — of the same size — by August. A supermajority of the Senate can also vote to amend the IPAB recommendations. If Congress fails to act, the secretary of health and human services is required to implement the cuts by

default. As you can imagine, the IPAB — which by law cannot consist of a majority of health-care providers — is about as welcome in some circles as a parent chaperone at a high-school dance. Eli Lilly CEO John Lechleiter said after the midterm elections that he’d lobby for its dissolution; the drug industry has said it will urge Congress to change or repeal the IPAB provision. Physicians, too, are concerned. So are hospitals and care facilities, but they won’t be subject to IPAB’s authority until fiscal 2020,  KHN notes. Providers worry about cuts to fees they already say are too low. And Rep. Paul Ryan, whose own plan for cutting Medicare costs involves reducing the government’s share of premiums, has described the board’s likely implications using the R-bomb: rationing. Read more from KHN’s explanation of the IPAB and tell us what you think. Image: iStockphoto

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Reader Consult: Can the IPAB Control Medicare Costs?