This morning, the House Budget Committee invited Health and Human Services Secretary Kathleen Sebelius to a hearing on the Independent Payment Advisory Board (IPAB), the left’s weapon of choice for tackling Medicare’s $38 trillion in unfunded promises to America’s seniors.

Both sides of the debate agree that extensive reductions to Medicare’s runaway spending are needed, and have even proposed comparable targets for growth in spending.  The key difference, then lies in who makes the difficult decisions regarding seniors’ health care under the chosen direction for reform: Patients, or bureaucrats?

Sec. Sebelius argued that IPAB, a board of unelected officials tasked with reducing cost growth in Medicare without congressional approval, would reduce spending by embracing better payment strategies.  This method is vague, at best, and what’s more, has been tried time and again, to no avail.  The truth is that the most likely way the IPAB will enforce Medicare’s new spending cap is through provider payment reductions, reducing seniors’ access to care.  As more providers decline to participate in the Medicare program, seniors will face longer waits for the care they need, experiencing the ugly consequences of top-down rationing of care.

As Budget Committee Chairman Paul Ryan (R-WI) pointed out during the hearing, there’s a better way to solve Medicare’s financial crisis and improve the quality of the program for those its serves at the same time—without government rationing, indirect or otherwise.  As he explains,

“Giving seniors the choice, like we did with Part D, is a better way because what it does at the end of the day is it shows providers that, if you want to succeed, if you want to have business, you gotta outcompete other providers for that beneficiary’s business.  So the nucleus of the program we’re trying to talk about is the patient, the beneficiary, not the IPAB.  And there’s the big difference at the end of the day.  We really believe, because of evidence, and reality, giving seniors more choices, or providers—doctors, providers, insurance companies, to compete against each other for that beneficiary’s business—that works.”

To hear the rest of what Rep. Ryan had to say to Sec. Sebelius’ defense of the IPAB, check out the video.  Then, visit http://savingthedream.org to read more about Heritage’s vision for patient-centered Medicare reform that builds on the successes of existing consumer-driven models.