Talk:Independent Payment Advisory Board

Sources & expansion

The law that created the agency is the most reliable source. -- Dauster (talk) 09:40, 16 September 2010 (UTC)

I agree that the law itself is the most reliable source for the text of the document, but not for critical analysis of such things as the environment in which it was crafted and passed, and it's impact (or lack there of) on CMS and the American health care reform movement(s). Also the law itself cannot provide information on criticisms, political implications, and legal challenges (such as the one by the Goldwater Institute). If independent third party WP:RS's are used, this information could be generated.

Putting {{primarysources}} on this article is an indication that all of this material is missing, and in order to expand the article to include it, we need additional text with citations that meet WP:RS. If there is a better tag for this purpose, please use that instead, but {{primarysources}} is was what seemed to work best. This kinds of tags are not some kind of badge of shame, or a criticism of the worth of the article or the value of this topic; they instead are merely useful indicators of additional work that needs to be done on the article to help it meet "good article" standards. -- 208.81.184.4 (talk) 16:26, 16 September 2010 (UTC)

Reception

I don't like this section. I think comments and continuing developments on IPAB should be placed in context instead of grouped together at the bottom of the page. I also do not like the idea of a "reception" section as it almost seems like an invitation to debate. Intermittentgardener (talk) 12:52, 19 December 2010 (UTC)

Fair enough. I'll move the legislative-related items up into a new "proposed legislative changes" section. -- Dauster (talk) 19:25, 19 December 2010 (UTC)

Removing almost all the material about the legislative debate on IPAB was not appropriate. Understanding healthcare reform is certainly a key reason why many readers would visit this article.Intermittentgardener (talk) 15:10, 20 December 2010 (UTC)

I am accumulating material on the IPAB debate and will be adding more text shortly focusing on aspects of the discussion beyond just rationing.Intermittentgardener (talk) 15:21, 20 December 2010 (UTC)

Cool. I note some tension between your first and second comments. I lean toward your first note that this article would not be enhanced by a rehash of the general health care debate. -- Dauster (talk) 10:57, 21 December 2010 (UTC)

I doubt, however, that the legislative history section is the right place for the tempest over claims of rationing. Legislative history should be about how Congress created the board. There should be some other heading for post-enactment debate over the board. -- Dauster (talk) 11:02, 21 December 2010 (UTC)

Perhaps a section titled "Expert opinion" would be a good idea. That way, it would be easier to curtail "debate". As is, Uwe Reinhardt's comments don't exactly match a description of IPAB objectives. And I am here because I listened to Atul Gawande's comments on the board.[1] Around minutes 34-37 he discusses the board. Jesanj (talk) 20:10, 11 January 2011 (UTC)

Article to be renamed Independent Medicare Advisory Board

The legislation that created the board calls it the Independent Medicare Advisory Board and not the Independent Payments Advisory Board. The bill does refer in places to "Independent Payment Advisory Board" but makes it clear that the proper name is INDEPENDENT MEDICARE ADVISORY BOARD. There are 18 instances of the term "Independent Medicare Advisory Board" and the other only 3 instances in relation to a correction.

See the consolidated bill which says

INDEPENDENT MEDICARE ADVISORY BOARD SEC. 1899A ø42 U.S.C. 1395kkk¿. (a) ESTABLISHMENT.

There is established an independent board to be known as the ‘Independent Medicare Advisory Board’ (øNote: Referred to as the ‘‘Independent Payment Advisory Board’’¿.

But please see section 10320(b) of the new law, which says: "(b) NAME CHANGE.—Any reference in the provisions of, or amendments made by, section 3403 to the ‘‘Independent Medicare Advisory Board’’ shall be deemed to be a reference to the ‘‘Independent Payment Advisory Board’’." Thus the original article title is the right one. -- Dauster (talk) 12:08, 9 January 2011 (UTC)

::I think the agency has gone through 3-4 name changes. But the present IPAB is correct. Angel's flight (talk) 21:01, 11 January 2011 (UTC)

Since the article name was changed to Independent Payment Advisory Board, can we change the name of this talk page to Talk:Independent Payment Advisory Board too? The redirect is a bit of a kludge. -- 208.81.184.4 (talk) 18:56, 25 January 2011 (UTC)

Improper removal of material

I was very disappointed by what happened on this article today. Properly referenced, NPOV, and encyclopedic material was deleted in about the rudest manner possible. If this behavior continues I will involve administrators.Intermittentgardener (talk) 19:38, 25 January 2011 (UTC)

Let me take a look at all the material was removed. I will tell you why I deleted it and you can then tell me why I am wrong. If I agree with you then fine. But if not we have to resolve the matter. Going back through the main removals in reverse order

1. this edit deleted text about "repeal efforts". Lets look at the "repeal efforts" and see if they really are repeal efforts. Here is the text "During the health care reform debate of 2009-2010 that ended with the passage of the legislation by the Democratic-dominated Congress, Republicans proposed striking provisions in the bill that would require Medicare cost control. While voting yes on the legislation in April 2010, one liberal congressman, Pete Stark (D-Calif.), said that the IPAB "sets [Medicare] up for unsustainable cuts" that will endanger the health of patients, and that he would "work tirelessly to mitigate the damage" the panel would cause.<“GOP staffer: Look to healthcare debate for repeal clues.” The Hill. (October 19, 2010)." And here is my reply. (1) an effort by Republicans during the passage of the bill IS NOT A REPEAL EFFORT! You can only repeal existing laws. (2) Pete Stark has not begun any repeal effort but he has presented an OPINION about the proposed board and how it might act. WP:OPINION tells us that "the article should represent the POVs of the main scholars and specialists who have produced reliable sources on the issue". Is Pete Stark a scholar?? Is he a specialist? I think not.
2. The same edit deleted this text "In August 2010, high-ranking Senate Republicans introduced a bill to repeal provisions for the panel, "saying that 'unelected, unaccountable bureaucrats' should not be given such significant power over Medicare."[2]" Question (1) Who is www.californiahealthline.org? Answer: It is, ultimately part of a foundation that emerged after the creation of Wellpoint as a for profit insurance company after Blue Cross of Calfornia lost its charitable status and becomae a for profit entity. Its independence has come into question after it seemed to eliminate references to press items critical of Wellpoint (see http://www.pnhp.org/news/2003/march/what_is_california_h.php). If we have a source which does not seem to be reliable or meet Wikipedia's standards, then we cannot rely on for quotes such as this.
3. Also deleted in the same edit was "Rep. Pete Stark, a Democrat from California who voted in favor of health care reform, said that IPAB is a "dangerous provision" that "sets [Medicare] up for unsustainable cuts" and endangers patients' health. "I intend to work tirelessly to mitigate the damage that will be caused by IPAB," stated Stark. Yet Stark, the ranking Democrat on the health subpanel of Ways and Means Committee, issued a 14-page talking point report in December 2010 to help other Democrats "hone their arguments" against repeal efforts by the Republicans.(Dems prepare defense of healthcare law in face of repeal threats [3] |author=Julian Pecquet|date=December 21, 2010|work=The Hill|accessdate=December 27, 2010) Again we have opinion from Stark. If there is to be opinion it ought to come from experts, and in any case it has to be balanced out with other opinions to create NPOV. This is not the case here, and furthermore placing this opinion in a section called "repeal efforts" makes it sound as though Stark has signed up for repeal efforts which, as far as I am aware, he has not.
4. This text also was deleted in the first listed edit deletions "IPAB has been defended as merely a tool to help control costs in an inefficient health care market.(web|url=[4]|date=August 2, 2010|title=Why The Health Reform Repealers Are Wrong|author=Jonathan Cohn|accessdate=January 14, 2010) As it happens this is from a reliable source and it is a strong defense of the law and the IPAB, However, the words "merely" and "tool" do not even appear in the article. It appears to me as though it has been added as a sop to people like me who demand that OPINION be BALANCED to create an NPOV. Describing it as "merely a tool" is totally biased editing. The editor who inserted this text deserves to be put through a Wikipedia editors re-education program.
5. this edit deleted this text "Speaking on the issue of delegating legislative authority Peter Orszag, former White House Budget director and IPAB supporter stated, "I believe this commission is the largest yielding of sovereignty from the Congress since the creation of the Federal Reserve.”([5], Can we control costs without Congress, by Ezra Klein, The Washington Post, 26 March 2010)" What is wrong with this? EVERYTHING! The quote is fine. I do not doubt that Orzag said this. But the section is entitled "Separation of Powers" - which is a constitutional term, Was Orzag talking about the consitution? Certainly not! He was talking about congress giving up the right to determine to Medicare reimbursement - i.e. the value to be given for a service rendered to the public. Congress does not approve the price of pens bought by the government, or the price of anything except it does for some inexplicable reason, get involved in Medicare reimbursement. Orzag's point is that Congress needs to give up the right to determine Medicare reimbursement. The edit was pure fantasy that Orzag was talking about the separation of powers.
6. I have reviewed again the section I deleted on constiutionality. In retrospect, apart from a small change to the section heading, I think that although this does contain Opinon and has not yet been determined by the judge in the case, it was a fair statement of both sides of the argument. When I revert your undoing of my edits (for all the reasons I have given in this reply) I will then back this section which does meet WP editing rules.
7. this edit deleted the following text "Efforts by the British National Health Service (NHS) to establish a system where approval of medical treatments is tied to their cost per quality adjusted life year (QALY) have been mentioned approvingly in support of IPAB. Under this QALYs equivalent to good health have a value of "one". An extra two years of life in a state of health rated half as good would also have a value of "one". The NHS National Institute for Health and Clinical Excellence frequently rejects treatments costing more than 30,000 pounds per QALY." I deleted this because not only was the linkage uncited, the IPAB is nothing at all like NICE in the UK. You can find all the arguments for this at Talk:Death panel because this article also tried to tie two organizations together when they are completely dissimilar. The claim was taken to WP:NPOVN and ultimately the person trying to defend its inclusion stepped back and deleted the section from the article.

So in summary I am going to revert your reversions of my edits but add back the section on legal challenges.

If you wish to challenge my edits please do so. But please give detailed explanations of the basis of your challenges. Simple reverts without explanation are NOT acceptable.Hauskalainen (talk) 03:29, 26 January 2011 (UTC)

You do in fact explain your reasons but the are all incoherent. Intermittentgardener (talk) 15:18, 26 January 2011 (UTC)

:::::Hauskalainen, you are editing tendentiously on this and related articles. You should stop. Your conduct has already come up once before at ANI, and at the rate you are going, it is likely to happen again. Angel's flight (talk) 03:03, 3 February 2011 (UTC)

why single out me? I have justified each of my edits and the other editor simply does not justify hers. Why is that? You seem to want those edits in also, so why don't you justify them? Try answering the substantive points I have made. Hauskalainen (talk) 03:12, 3 February 2011 (UTC)

:::::::Your editing is tendentious because you ignore the justifications that others make. Your basic argument, repeated ad infinitum, is that you disagree with what the cited sources say, so therefore you must delete the references. That's not how Wikipedia works. You could be the most competent health care analyst in the world, but under Wikipedia policy, we must still include viewpoints that you disagree with, provided that they are published in reliable sources, which they are. Angel's flight (talk) 04:09, 3 February 2011 (UTC)

DOJ source

How can I verify the DOJ source "Department of Justice. Coons v. Geithner, Response to Plaintiffs’ Motion for Preliminary Injunction. Filed December 10, 2010."? Thanks. Jesanj (talk) 23:33, 3 February 2011 (UTC)

Lexis has it. Intermittentgardener (talk) 23:18, 4 February 2011 (UTC)

lopsided

This looked lopsided because it doesn't appear the DOJ says anything about the constitutionality. Jesanj (talk) 23:34, 3 February 2011 (UTC)

notability?

Why are we citing legal issues from WP:PRIMARY sources such as goldwater's website and the DOJ? This is a task for WP:SECONDARY sources, in my opinion. Jesanj (talk) 02:24, 4 February 2011 (UTC)

WP:NOTADVOCATE WP:NPOV

This edit summary, states "removed misleading text. There are NO serious efforts to have the IPAB proposals repealed. It has widespread support". This edit summary is contradicted by published material, which states

“ Drug companies fear the board may consider reducing subsidies to Medicare prescription drug plans. They also want stronger congressional oversight of the board. The CEO of drugmaker Sanofi-aventis, Chris Viehbacher, told Kaiser Health News he wants the provision repealed or amended ... “There needs to be transparency and oversight. [The board] has to be accountable. ... Their evaluation is going to be flawed, because a major chunk of costs aren’t included, like ... hospitals, and there needs to be a process of oversight,” said Viehbacher, chairman of PhRMA’s board of directors. ... “The AMA will work to stop the IPAB from causing this type of double-jeopardy situation for physicians and compromising access to care for seniors and baby boomers.” ... The providers’ messages resonate with many congressional Republicans who have attacked the board for its expansion of government power over the health care system. ... Georgia Rep. Phil Gingrey, a physician and co-chairman of the 18-member Republican Doctors Caucus, said in searching for cuts, the board will have no choice but to target “payments to providers. We just absolutely must repeal that provision.” Many House Democrats share that view. Last January, 72 Democrats joined their Republican colleagues in sending a letter to then-Speaker Nancy Pelosi (D-Calif.), opposing the board. In September, 14 Democrats, three of whom were reelected, voted to repeal the board." ”

Though yes, the article states "Those who want to kill or weaken the board face significant hurdles." Please stop the POV & battleground editing. Jesanj (talk) 14:40, 4 February 2011 (UTC)

text regarding constitutionality

I removed the following text from the article again:

Constitutionality

Some opponents of IPAB argue that it amounts to unconstitutional "entrenchment." Specifically, Jeff Flake, Trent Franks, and John Shadegg, Members of the United States House of Representatives argued that allowing IPAB proposals to become law without congressional or presidential approval and the requirement that IPAB cannot be repealed until 2017, and then only under stringent rules, unconstitutionally restrict the freedom of future congresses to pass legislation in violation of the First Amendment, the Separation of Powers, and the Article I powers of Congress.

A motion drafted by the conservative Goldwater Institute has requested that District Court Judge Murray Snow issue an injunction against provisions of the healthcare reform law that restrict repeal of IPAB. In its brief defending the law, the United States Department of Justice says: "the challenged provision does no such thing. Rather, it creates a parliamentary procedure whereby Congress may use an expedited process to consider legislation that would discontinue the Independent Payment Advisory Board . . . . Plaintiffs’ claim that the provision somehow blocks repeal is simply incorrect. As with all statutes, plaintiffs remain free to introduce or vote on legislation to repeal the statutory provision that creates the Board."

I have raised some issues above but they were not discussed any before the material was reinserted into the article. Please discuss. Thanks. Jesanj (talk) 17:47, 4 February 2011 (UTC)

I do not see the issue. There is at least one lawsuit brought by members of Congress pending that says IPAB is unconstitutional. The Justice Department has a different take on the matter. The facts of the case and the opinions of both sides are being presented here. This text is NPOV, properly sourced, describes a significant event, and is on topic. I am reinserting it. Intermittentgardener (talk) 18:22, 4 February 2011 (UTC)

There are multiple issues I raised above that you have not addressed. I will restate them here. 1) How is the DOJ source verifiable? 2) Why is this notable (significant) since I don't see any coverage from reliable secondary sources such as mainstream press? 3) How does the DOJ quote balance out the POV that the IPAB is unconstitutional? Jesanj (talk) 20:10, 4 February 2011 (UTC)

After looking at the sources, I agree with your first point. Goldwater can only be considered a reliable source with respect to their own opinions. That may be enough in this case but an account from an established media outlet would be much better. With respect to number two, I disagree. The source quoted is a primary source as opposed to a secondary one but given that it is only being used to support a statement about the government's opinion on the case it is enough. As for point three, I don't really understand. We have the plaintiffs perspective in the first paragraph and the government's perspective in the second paragraph. How is that not balance? I will look around for some better sources on this. Intermittentgardener (talk) 23:17, 4 February 2011 (UTC)

Here is one source that seems to be reliable enough. http://thehill.com/blogs/healthwatch/health-reform-implementation/114165-ariz-congressmen-join-health-reform-lawsuit- Intermittentgardener (talk) 02:24, 5 February 2011 (UTC)

It only cites an allegation but does not state the basis of the allegation or pass judgment on it. What in the legislation is the basis for the legal claim that it will "unconstitutionally restrict the freedom of future congresses to pass legislation in violation of the First Amendment"? It is an alarming allegation, but what is it based on? I do not see it.Hauskalainen (talk) 12:05, 5 February 2011 (UTC)

Thank you Intermittentgardener for giving us a WP:SECONDARY source for this issue. It's a blog, but still, it's a secondary source, so it's a start. One concern I have is that it is an "Arizona suit". That makes it sound a bit more trivial. I'm not sure how important it is in the encyclopedic sense. Maybe we could say "As part of legal challenges from conservative organizations and 20 U.S. state's attorney generals (sp?), to the Affordable Care Act, Arizona's conservative Goldwater Institute filed a suit against the IPAB, with three Republican legislators from Arizona". Haus, we could easily not include that in the article, to prevent covering silly (in the sense these are hashed out in WP:PRIMARY sources) legal arguments. But still, there appears to be hardly any coverage of this in secondary sources. I'm not convinced it belongs, but if we do decide to, I'd support something like what I put in italics. Jesanj (talk) 13:23, 7 February 2011 (UTC)

Hauskalainen, you are confused about our mission here. 1.) The fact that the article does not pass judgement is a good thing. If it were an opinion piece it would only be evidence of its author's opinion and could not be used to reference the facts of the case. 2.) It is not our job to to evaluate the arguments made. Our task is to faithfully report what has happened according to the sources. This lawsuit happened and it is significant. Intermittentgardener (talk) 14:44, 7 February 2011 (UTC)

Here are more sources. [6], [7]. Also there is a whole article (well sourced) devoted to this lawsuit Coons_v._Geithner. This suit is relevant to IPAB, notable, and reflected in secondary sources. There is no reason to keep it out. Intermittentgardener (talk) 14:55, 7 February 2011 (UTC)

The East Valley Tribune source doesn't mention the IPAB. The Verde Independent, with the author from Capitol Media Services, appears questionable. How would we know it is a reliable source? I'd like to see a national newspaper, or a health care source such as Health Affairs or Kaiser Health News to eliminate my concern over the potential lack of importance to the topic. Jesanj (talk) 15:13, 7 February 2011 (UTC)

Capitol Media Services is a long established wire service and The Verde Independent is a daily newspaper that prints hardcopy. I do not see a problem.Intermittentgardener (talk) 15:23, 7 February 2011 (UTC)

I support the text above in italics and recommend citing the East Valley Tribue and the Hill. Jesanj (talk) 15:20, 7 February 2011 (UTC)

I for one do NOT. Listen again to what it says

::::::U.S. Reps. Jeff Flake, Trent Franks and John Shadegg are part of the suit, which argues the Republicans won't have the right to repeal the health care bill. The plan aims to contain costs through the powerful Independent Payment Advisory Board that lacks meaningful oversight by Congress or courts, Bolick said. Congress can repeal the law only during a brief time in 2017, Bolick said, which violates the separation of powers doctrine.

They are not talking AT ALL ABOUT REPEALING THE NEW HEALTHCARE LAW. THEY ARE TALKING ABOUT CHALLENGING MODIFICATIONS OF THE PRICE THE GOVERNMENT IS PREPARED TO PAY FOR HEALTH CARE FOR THOSE IN MEDICARE. The price that the government is prepared to pay for pens or paper or legal services is not determined by law. And neither will be the price of medical services in Medicare. IPAB will recommend the price and that will come into force UNLESS Congress says otherwise. This gives full (small d) democratic control to congress to prevent this from happening if they so decide. Sure, they cannot challenge the first decisions of IPAB until after they have been in published, and that of course is in July 2014 leaving the rest of the year for congress IN ITS OVERSIGHT AUTHORITY to challenge the recommendation which will come into force 6 months later in January 2015. Where do those other dates come from? The article IS MISLEADING IN THE EXTREME. The article says "health care bill" when what it really means is "recommendations of IPAB."If you try to include it as a reference I will delete it for being unreliable. Hauskalainen (talk) 16:56, 7 February 2011 (UTC)

Once again, you are confused about how things work here. We do not pass judgement on what is reported in the media. Our job is to faithfully recount what has been reported by secondary sources. How we feel about the IPAB has nothing to do with what we include in the article. You cannot delete things just because you do not like them. Intermittentgardener (talk) 17:22, 7 February 2011 (UTC)

If you were trying to make the point that the East Valley Tribune doesn't mention the IPAB as part of the suit, then I got it, and it really shouldn't be cited. So, I am oscillating between wanting another source besides the Hill blog or including the sentence above in italics. Jesanj (talk) 17:21, 7 February 2011 (UTC)

Temporary protection

Pursuant to recent thread at the administrator's noticeboard, here, this article has been protected for 24 hours. Contributors are reminded, please, to work constructively towards consensus on the talk page, utilizing dispute resolution, including reaching out to the wider community for further opinions if necessary. Constructive consensus building involves civil communication about the development of articles and taking reasonable time to allow feedback from others. Content disputes should not be worked out by repeated reversions, but by communication here. --Moonriddengirl ^(talk) 23:33, 4 February 2011 (UTC)

I have been constructive and given full explanation of my edits. It is the other editor who is simply reverting without using the TALK page. See also my warning to the other editor which you may not have seen because it was on his talk page (though I did mention it AN/I). ThxHauskalainen (talk) 11:51, 5 February 2011 (UTC)

I am not planning to fracture this discussion. It is at all WP:ANI, including where I find you also at fault. --Moonriddengirl ^(talk) 12:11, 5 February 2011 (UTC)

Indeed you made a similar allegation there and I will gladly take your reply to my concerns there. Thanks.Hauskalainen (talk) 12:25, 5 February 2011 (UTC)

POV Pushing

Yesterday I had to warn Intermittentgardener about blatant POV pushing here. I was asked to cross post that warning here also and have thus done so. Hauskalainen (talk) 11:41, 5 February 2011 (UTC)

I see that Intermittentgardener has been up to his old tricks again. Look, there is no justification for mixing up OPINIONS which everyone has about things with the LEGISLATIVE PROCESS which is a very different thing. It is far better to have OPINIONS in a clearly defined section. It is clear that some people pushing a POV clearly wants that there should be a section named "rationing" because that would draw the reader towards an argument that IPAB is a rationing body. But it is not. The rationing argument is (a) a fringe theory and (b) rationing is not even the right word for what it will do. As far as I know, IPAB will not be issuing coupons telling who can get health care and who cannot. It will just set the price for something that the government buys for the people it insures. If the government decides that today it will pay 10 cents less per pound for the lemons it buys for use in government canteens, nobody in their right mind would claim that the "government is now rationing lemons". Its complete nonsense. And what's more, I think he knows it.Hauskalainen (talk) 17:35, 7 February 2011 (UTC)

Right now the article states "Some critics of IPAB do, however, argue that the board will lead to rationing". And there is a section titled "Allegations of rationing". My concern is that there is no allegation cited. Some critics is ridiculously vague and meaningless, in my opinion. To me, there is something obviously wrong here. Jesanj (talk) 17:43, 7 February 2011 (UTC)

Yeah, the rationing argument is really overblown but regardless of the merits it is part of the debate. Our account should be faithful to what is happening according to sources. If you really do not believe that rationing is part of the debate on IPAB go to Google and type in "IPAB" and "rationing". You get a ton of hits with people making allegations of rationing. Intermittentgardener (talk) 18:22, 7 February 2011 (UTC)

That is not the point. They have to be mainstream views. That means from "experts" according to WP:RS. These are not from experts. These are just from people playing politics and doing a "chicken licken" impression claiming that the sky is falling in. Its all fluff and there are no experts that I have seen referring to IPAB as a rationing body. Not everything that is published, even by reliable sources, meets the requirement for inclusion. The only time we had an expert refer to "rationing" was Uwe Reinhardt pointing out how the political game prevents real and useful changes, however minor, from coming into effect. That was in a reliable source but he was not claiming that "rationing" was a likely outcome. Neither for that matter was Brendan Nyhan. Misquoting and taking out of context is not what our job as editors is to do. It is to reflect the best knowledge of experts in their field and report all mainstream opinions without giving undue weight to any one of them. Creating sections with the words RATIONING and REPEAL EFFORTS gives WP:UNDUE weight to ideas that are not really really reflective of real life. Just political rhetoric. That is why they either should not be here or else presented in a balanced way in a section containing a range of all opinions.Hauskalainen (talk) 18:35, 7 February 2011 (UTC)

Opinions do not need to be from experts in order to be relevant.

The political debate on IPAB is entirely relevant. In fact, I suspect it is a reason why many people visit this article in the first place. Almost every mention of IPAB is either a defense or criticism. IPAB is contentious and we have to report the dispute in order to be faithful to the facts as stated in the available sources.

As for undue weight, most articles on IPAB focus on the political controversy surrounding it. Rationing and repeal are frequently mentioned. Rationing, in particular, is central to the debate on IPAB.Intermittentgardener (talk) 18:49, 7 February 2011 (UTC)

Please bring some reliable sources to this discussion if you think rationing should be important to the article. Some of what you're saying is "the debate" may not be worthy of inclusion here. Jesanj (talk) 18:56, 7 February 2011 (UTC)

user:Intermittentgardener is simply wrong. WP content is based on information collected and reported on by experts. Sources of information about science comes from scientists and if there is a difference of opinion amongst scientists then we include all the MAJOR opinions and not ones that are not taken very seriously. With articles about setting the price that should be paid for medical interventions, the expertise would be cost accountants in medical services providers (providing seller side costs) and medical service buyers such as insurers, including the single biggest, Medicare/HHS who would be expected to know both the medical value of what they are buying and the prices being offered in the market where they buy. The opinions of the caucuses in congress are notable because of the collective power they hold as representatives and because the electorate expects them to listen to the experts. This is why congressional hearings are important. The individual views of a handful of politicians which is very different from all the others is in the caucus is not notable because of WP:UNDUE. The views of college lectures, even if they work in a healthcare field would not be notable. Neither would a PC store owner raising suits in court against the law are not necessarily notable, though they might become so if the judge rules in their favor. Until that time their view is just one of many and not particularly notable.Hauskalainen (talk) 22:36, 7 February 2011 (UTC)

Again, I'll say, you appear to elevate WP:OPINION, an essay, to policy. It suggests we should "represent the POVs of the main scholars and specialists who have produced reliable sources on the issue". Jesanj (talk) 22:47, 7 February 2011 (UTC)

This lefty source distinguishes between some Republican claims of rationing and "reality". Maybe we should write Republican X has charged the IPAB would ration, but Mother Jones reports this is disconnected from reality. Jesanj (talk) 03:46, 8 February 2011 (UTC)

That sounds like a fair characterization based on my reading of the source. It seems that I was sloppy about putting this material together. I am re-reading the sources and putting the sections that have been removed back together in a more faithful manner. Intermittentgardener (talk) 04:42, 8 February 2011 (UTC)

Disputes at Independent Payment Advisory Board

There is a lot of conflict at this article. It would be great if we could get more editors involved to build consensus. Intermittentgardener (talk) 18:25, 7 February 2011 (UTC)

Washington Post story & Phil Roe

Pinch me if I'm dreaming, but Phil Roe wrote an op-ed attempting to associate the IPAB with the "death panel" term. It appears this story Health-related money continues to flow to members of Congress by R. Jefferey Smith, February 6, 2011, mentions him, $ and the IPAB. Jesanj (talk) 03:15, 8 February 2011 (UTC)

Unfortunately, the death-panel meme is tied to IPAB. Intermittentgardener (talk) 04:45, 8 February 2011 (UTC)

Mother Jones says "Republicans have also been egged on by Sarah Palin, who spawned the myth that the federal law would create 'death panels' throughout the debate. Though she originally targeted Medicare-supported end-of-life counseling sessions that never made it into the final bill, Palin expanded her attack to include IPAB as well."[8] While there are clearly Republicans who want the term "tied" to the IPAB, I think you're overstating things. Jesanj (talk) 12:50, 8 February 2011 (UTC)

Also, Palin first tried to smear the IPAB with the phrase in a December 2009 Facebook post, but she was ignored by the media. Contrast that with August 2009, when the fury almost brought down all Democratic health care reform. In December 2010, she got an op-ed in the WSJ with dp-like. Then FactCheck called her out... Sure, Phil Roe ($) would support the association, but what reliable sources do? I suppose though, as much as his opinion is wrong, it is notable here. Jesanj 13:30, 8 February 2011 (UTC)

Where exactly

I didn't see this material in the source. Where is it? Jesanj (talk) 21:48, 15 February 2011 (UTC)

Political debate section

Political debate is not what Wikipedia is for. Nor are the opinions of individual politicians particularly informative unless they reflect the policies of the party they represent. I have grave reservations about this section meeting WP standards for inclusion of material and its POV. For example the section on the opinion of politicians on the bi-partisan political group on the budget voted overwhelmingly in favour of strenghtening IPAB but this political opinion has been removed from this section.

According to Wikipedia's rules, we have to reflect the main stream opinions of EXPERTS. IPAB is a body that determines the reward structure for medical services provided to the elderly and to the disabled. What we need are the opinions of experts in this field. That I guess means medical econonomists, people already working for Medicare, doctors involved in Geriatric medicine and the needs of the classes of disabled persons in receipt of Medicare, cost accontants working for hospital groups etc. The opinions of politicians (who lets face it, have received hundreds of millions of dollars if not billions from the medical industry and who are constantly lobbied) are NOT independent observers in this field. I do not think that politicans (especially ex politicians such Palin and Gingrich) count for very much.Hauskalainen (talk) 07:14, 16 February 2011 (UTC)

This is why I think the section should be called opinion and not political debate. It should only contain the opinions of experts. Wikipedia is not a forum for airing political debate. We should concentrate on the opinions of experts supported by factual data. Yet again the user User:Intermittentgardener is using Wikipedia for purposes of propogating a political view of IPAB that is held by a minority of people and not reflecting the wide support that IPAB has from real experts, or moving those opinions to another section so that it seems that opinions are more strongly on the side of his/her preferred POV than they really are. For instance the section used to say that the law explicitly forbids rationing, but after his edits he has reduced this to "Mother Jones reported that, in reality, the rules governing IPAB explicitly bar 'any recommendation to ration health care.". If people are alarmed about the rationing of care they should take comfort in the fact that the law forbids IPAB from doing this. Reducing this fact to a statement that "someone says that the rules disallow this" gives a wholly misleading picture. The law forbids it. FULL STOP. I want User:Intermittentgardener to justify his edit that did this. Though not factually incorrect, it is misleading.Hauskalainen (talk) 10:12, 16 February 2011 (UTC)

(I'm pretty sure you're wrong. I added the WaPo/Roe/Mother Jones material. Perhaps you should exercise more care before slamming an editor.) I'm fine with removing the "Mother Jones reported that" part. Again, there is no prohibition against us reflecting the stupid things politicians say. For the third time, it appears you are elevating WP:OPINION, an essay, to policy. Jesanj (talk) 13:04, 16 February 2011 (UTC)

What POV am I pushing? I have added material for and against IPAB. I am just trying to faithfully relay the debate over IPAB.Intermittentgardener (talk) 16:33, 16 February 2011 (UTC)

:::This question has come up a few dozen times now. The standard for inclusion is not whether the opinion is correct, politically, scientifically, or otherwise, but whether it has been published in reliable sources. If in the judgment of editors the opinion is dubious, then it should be properly attributed so that the reader knows where it comes from. And Hauskalainen, I must request that you refrain from asserting your own personal opinion about the correctness or incorrectness of published commentary about IPAB and related topics. It's pretty much irrelevant under Wikipedia policy. Angel's flight (talk) 16:49, 16 February 2011 (UTC)

Where did "politically" come in to the equation? WP:OPINION says it is the opinions of EXPERTS that may be included in Wikipedia. Thus medical articles carry the opinions of medical researchers and not quacks; science articles carry the opinions of scientists and not people who base their understanding of the world in terms of the supernatural. It is not enough just to say that opinions are published by reliable sources. They have to be the opinion of EXPERTS. Health economists would be the best professional group to provide professional expert opinions on the subject of a body designed to set the price paid for health care. Sarah Palin and Newt Gingrich do not pass muster.Hauskalainen (talk) 20:26, 16 February 2011 (UTC)

I agree with your respect for experts in the relevant field, but that doesn't mean we can't allow Palin or Gingrich to be cited. I suggest you read up on the differences between policies, guidelines, and essays. As this is the fourth time I am making the point to you, it appears you are hard of hearing. WP:OPINION is just an essay. Jesanj (talk) 20:53, 16 February 2011 (UTC)

::::::Seconded. Angel's flight (talk) 02:03, 17 February 2011 (UTC)

Comment: Edits by a sock of a banned user have been struck through.   Will Beback  talk  21:02, 17 February 2011 (UTC)

I don´t see problem to include what notable politicians think about the topic. Wikipedia is not from paper. --Dezidor (talk) 09:35, 17 February 2011 (UTC)

On what grounds are the opinions of Gringich and Palin valid as far as IPAB is concerned? These are ex-politicians. Currently they represent NOBODY BUT THEMSELVES. At any one time there must be THOUSANDS AND THOUSANDS of ex politicians in the United States. Why are the extreme opinions of a few politicians relevant to the article and the opinions of the very much larger body of more moderate ex politicians who stay silent because they do not regard IPAB as controversial not to be represented here? That means the article is unbalanced. It is not enough to claim that their statements are published by reliable sources. If all the wacky things that were ever said made them eligible for inclusion, Wikipedia would be full of the weirdest things that fill newspapers everyday which are notorious only for their weirdness. The cranky sayings of retired politicians are not NOTABLE even if they are published, except perhaps in their own articles if properly attributed. Do we publish the opinions of Adolf Hitler in the article on Downs Syndrome for instance if he had argued that they should be sterilized? There is an ex politician who had some extreme views. No, we have a higher standard than that. If everything that ever got published could be put in WP it would be full of junk. WP has high standards. Opinions have to be the opinions of EXPERTS and political efforts are only meaningful if they garner widespread support. If there are to be political views, they ought to be in the mainstream. Thus for example, if the Republican party said on its web site that IPAB was an evil concept and must be done away with, then this would be a mainstream opinion and a notable one that could be reported in WP. If a couple of members of the House of representatives initiate a bill to eliminate IPAB, that is NOT NOTABLE unless it stands a chance of getting the backing of the party as a whole in Congress. The views of ex politicians who represent no one but themselves are NOT notable opinions.Hauskalainen (talk) 15:05, 18 February 2011 (UTC)

The purpose of a Wikipedia talk page ... is to provide space for editors to discuss changes to its associated article or project page. Article talk pages should not be used by editors as platforms for their personal views on a subject. Would you please discuss changes to the article? Jesanj (talk) 15:54, 18 February 2011 (UTC)

I reverted your attempts to remove material. You talk about Palin being out of office, and then you also remove Phil Roe, who has submitted legislation to eliminate the IPAB. Palin was obviously wrong, but that doesn't stop her from getting published in the WSJ, so we can decide whether or not it is notable. Right now, I'm leaning towards thinking it is notable. The White House was concerned. Palin followed through. FactCheck checked her. Seems OK here. When you say "Why are the extreme opinions of a few politicians relevant to the article and the opinions of the very much larger body of more moderate ex politicians who stay silent because they do not regard IPAB as controversial not to be represented here? That means the article is unbalanced. I think you are reaching an erroneous conclusion. You seem to know the truth about things, even when they are not published. But, in order for something to be POV, it would have to distort published material. Silence doesn't get published... Funny how you can read their mind. Jesanj (talk) 19:14, 18 February 2011 (UTC)

Hauskalainen, you are continuing to edit war and POV push. Knock it off. If you do not I am going to report you for edit warring.Intermittentgardener (talk) 19:29, 18 February 2011 (UTC)

And I will immediately report you for being a suspected sock. The evidence is looking ever more convincing as time goes by. Hauskalainen (talk) 07:46, 19 February 2011 (UTC)

@Jesanj Firstly, your comment following my comment of 15:05, 18 February 2011 (UTC) shows that you cannot justify including the views of ex politicians who represent no one but themselves. WP is not a place where talking points in debates get aired. It is especially misleading if the views aired are not in the mainstream. Now you claim that it is me that is POV pushing! Why would I do that? I do not even live in the US so I am not affected by the health care system and I do not benefit by taking mone from it. Phil Roe and Pete Stark do benefit from the medical services industry. Their views are probably tainted by the money they receive. These are NOT neutral observers and experts that WP:OPINION says we should use as our sources for claims of interpretation. Secondly, you are highly selective as to which opinions go in here. Why aren't you arguing that we put back Pete Orzag's opinion (a former budget director and therefore a person with practical administrative expertise) who argued that IPAB is going to be the trans formative change needed to fix the budget crisis in years to come? I liked the Nyhan article, which says a great deal about why government needs to get involved to fix America's health care system (which is run for the benefit of special interests rather than the people, but the only snippet you want from his bit is a reference where he says the new law may (my emphasis) lead to more restrictive rationing....) when actually his substantive argument is not about IPAB or rationing. You only want the bit that says "more restrictive rationing" because it suits the talking point you want included and that is that it is about rationing (even though the law forbids rationing of any kind!). I don't know what Nyhan was referring to (and I suspect you don't either) because he does not tell us. It was not his point, but you have taken him out of context and made it seem that it was. Sure, the pieces you want in the article are published opinions but as I have said over and over, not everything that gets published makes it eligible for inclusion in Wikipedia. Most of it is unencyclopedic. Thirdly, you claim that I cannot know what the silent majority are thinking. That is of course true. But if the silent majority were all in favor of abolishing IPAB then the bill calling for that would have been passed by now. What happened to it? Sweet FA because it has NO SUPPORT. So its not a case of being able to read minds but checking on their deeds. The latter is far more reliable. There must have been republicans on that bi partisan committee that voted in favor of bringing forward in time some of IPAB's assigned tasks. Now you are saying that "i'd be fine with removing pete stark if we put uwe reinhardt back in saying why some democrats may not like the idea (less power) -- which means less reason to get $" which clearly shows again that you are editing for political purposes. The reason WP allows the opinions of experts is that they tell us something from their deep knowledge of their subject area. I agree that Reinhardt meets the criteria as a person whose opinion is worthy of including. He is a medical economist and one of the few real experts. And from what I have read he is sceptical that IPAB can do more than make a slight dent in the huge financial costs of health care in America (and as your comment shows he recognizes that even Democrat politicians have their fingers in the health care pie) though I think he regards it as a step in the right direction. We should discuss how to summarize his views and get them in the article. Hauskalainen (talk) 07:46, 19 February 2011 (UTC)

Orzag definitely belongs. Observers do not have to be neutral. WP:OPINION is just an essay. Of course money corrupts, but you are trying to hold Wikipedia to a higher standard than it aims for, in my opinion. (Please don't bring in your dissatisfaction with death panel here.) Whether or not we include published things is left to our discretion. I agree that Uwe Reinhardt definitely belongs too. We could probably just go back to an old version and copy and paste, for a start. FYI, my political POV pretty much matches up with how you characterize Reinhardt's views on the IPAB. Jesanj (talk) 15:27, 19 February 2011 (UTC)

Now answer the substantive questions that I asked you. (1) Why is the opinion of Newt Gingrich important? He does not represent anyone but himself. He has been out of public office since 1999. (2) Why is Palin's opinion important? Not only is she not representing anyone either, she has actually abandoned the public responsibilities she once sought. Neither as far as I can tell have any expertise in matters medical. And I would argue that the ONLY reason that you want the Nyhan quote in the article is because of that completely out of context quote about "more restrictive rationing". This was not the subject of his very lengthy article and quoting him out of context is both misleading and highly revealing of the POV you are trying to push into the article. So (3) if I remove that quote and replace it with something more fitting the argument he actually makes, will you be okay with that? If you are not trying to push a POV but are genuinely interested in having Nyhan's opinion in the article, you ought to accept this proposal. Hauskalainen (talk) 13:36, 20 February 2011 (UTC)

For the second time, please stop discussing death panel at this talk page. How about posting that there? Jesanj (talk) 16:29, 20 February 2011 (UTC)

I concur with the view of Jesanj that the "death panel" libel would better be discussed at the death panel article. -- Dauster (talk) 17:43, 20 February 2011 (UTC)

Palin WSJ charge & FactCheck response

An editor has expressed the idea that this content[9] is not worth including, and removed it. I undid the edit.[10] It was removed again by the same editor who finds it problematic.[11] Someone else restored the information.[12] It was removed again by the same editor.[13]

The first edit summary which removed this information said "remove more Palin. She is no expert and represents no one". The last edit summary which removed this information said "removed unencyclodepedic content.Palin's fame is her ignorance (Katie Curic interviews) and propensity to tell whoppers ("Lie of the year" no less). We should not repeat this nonsense even with the put down it got."

I have a few problems with the logic of removing this content:

1. Just because Palin is more likely to be wrong than an expert does automatically make her unencyclopedic. Whether her statements belong in any article depends on the context of each statement.
2. The put down makes it more notable.
3. White House officals have been concerned about "death panel" slandering of the IPAB, making it more relevant to the article.

In my mind, it seems moderately notable that Palin made this claim given the context of the concern and the fact-checking. Jesanj (talk) 12:40, 22 February 2011 (UTC)'

So how does it meet the requirement that opinions included in Wikipedia have to come from experts? The opinions of non-experts are pretty much meaningless. Why should the opinion of Sarah Palin be included? Does she hold elected office? Has she a degree in Health Economics? As I have said time and time again in the previous section (which you have deliberately tried to sidestep by claiming that I am talking about a different article), WP policy holds us to a higher standard than say content you might find in a newspaper. It is not enough just to say that it has been published by a reliable source. It has to be meaningfully informative about the subject matter of the article. And that is the problem. The only thing the meaningful content that can be got from the passages you added back is that it tells us something about Sarah Palin. That she shoots her mouth off telling lies and gets pulled back by fact check organizations run by national and regional newspapers. Therefore by all means add this to the Sarah Palin article, but it has zero relevance to the article about IPAB because is tell us NOTHING about the board. That is why it is irrelevant and unencyclopedic.Hauskalainen (talk) 13:44, 22 February 2011 (UTC)

I think the FactCheck material tells us something about the board. And I think Palin does too. It shows readers that there are misconceptions out there about the board and it shows how those misconceptions contrast with "reality". The Wikipedia page on opinion is just an essay. Experts are invaluable to Wikipedia, but that doesn't mean non-experts are never encyclopedic. There is no requirement that opinions have to come from experts to be Wikipedia worthy. Jesanj (talk) 13:52, 22 February 2011 (UTC)

The fact is that essays are guidance so we ought to follow them too. But if you want a core reason I point you towards these extracts from WP:NPOV (bolding is mine)

" Giving due weight and avoiding giving undue weight means that articles should not give minority views as much of or as detailed a description as more widely held views. Generally, the views of tiny minorities should not be included at all. "

And this:-

"Wikipedia should not present a dispute as if a view held by a small minority deserved as much attention overall as the majority view. Views that are held by a tiny minority should not be represented except in articles devoted to those views. To give undue weight to the view of a significant minority, or to include that of a tiny minority, might be misleading as to the shape of the dispute. Wikipedia aims to present competing views in proportion to their representation in reliable sources on the subject. This applies not only to article text, but to images, wikilinks, external links, categories, and all other material as well."

It is very clear that this view of IPAB is not widely held. Promoting it in Wikipedia is what Jesanj and Intermittentgardener are up to and it should not be tolerated. Hauskalainen (talk) 22:56, 22 February 2011 (UTC)

Also, the essay about opinions says "the article should represent the POVs of the main scholars and specialists who have produced reliable sources on the issue". I wholeheartedly agree. We need Orzag and Reinhardt. But the above quote does not mean we have to exclude non-experts. That would be a novel conclusion, in my opinion. Jesanj (talk) 15:34, 22 February 2011 (UTC)

@Jesanj you say "the above quote does not mean we have to exclude non-experts but of course it really does mean that. The opinions of non experts are not meaningful at all except for what it tells us about the person with those views. That is why we have articles on subjects such as creationism (which shows that this is belief based on religion and not based on science) that are completely separate from articles offering the best scientific evidence about the origins of the universe and life within it. Mixing up the two things is not something that we should do and it is why they are completely separate in Wikipedia. I would be happy for your text to appear in the Sarah Palin article because it tells us about Sarah Palin and not the IPAB. Hauskalainen (talk) 22:56, 22 February 2011 (UTC)

I disagree with your interpretation of the essay. If you were talking about us working on a section regarding the IPAB's mission, I'd be on board, but we're talking about a section currently titled "Political debate". I'd wholeheartedly expect any section like that to have some non-experts saying stupid things. Jesanj (talk) 17:49, 23 February 2011 (UTC)

I agree that it should be left out -- it's too far away from reality to be encyclopedic, even with the FactCheck smackdown included. It might make sense at the Death panel article, though.--SarekOfVulcan (talk) 18:28, 22 February 2011 (UTC)

I strongly believe that it should be included. That it may be "too far away from reality" is not relevant. The IPAB was described as a death panel by a major public figure. A very large percentage of the media coverage on IPAB focuses on this issue alone. Intermittentgardener (talk) 20:43, 22 February 2011 (UTC)

Just because the media covers it does not make it encyclopedic.Hauskalainen (talk) 22:56, 22 February 2011 (UTC)

And to the three points I made above I would say 4) Palin's mention was also highlighted by a Mother Jones article: "Among the first targets is a little-known provision creating an independent Medicare panel whose purpose, Republican critics insist, is to ration care and could speed patients to an early death—in other words, the 2011 incarnation of Sarah Palin's "death panels." & "Republicans have also been egged on by Sarah Palin, who spawned the myth that the federal law would create "death panels" throughout the debate. Though she originally targeted Medicare-supported end-of-life counseling sessions that never made it into the final bill, Palin expanded her attack to include IPAB as well."[14] Jesanj (talk) 20:46, 22 February 2011 (UTC)

I'll say to you what I said to your alto-ego. Just because the media touches something does not make it worthy of inclusion in the encyclopedia. If the Republican party made an official statement claiming that IPAB was "death panel" that would be a very different matter. It would make it notable. So far I am not aware that the party has said anything remotely like this. Death panel was a lie of the year in 2009 and its repetition in 2010 against a different target is not likely to enhance Palin's reputation for accuracy (if ever she had any). Hauskalainen (talk) 22:56, 22 February 2011 (UTC)

While it is not an official party statement, the Mother Jones article does read "It's Alive! GOPers Resurrect 'Death Panels'". Jesanj (talk) 02:40, 23 February 2011 (UTC)

A tiny number of GOP members do not make party policy. Hauskalainen (talk) 10:32, 23 February 2011 (UTC)

I'm not stating it is party policy. But Phil Roe, who has twice submitted legislation to abolish the IPAB, says he accepts the term as a descriptor of the IPAB: "When asked on Wednesday whether he would link the board to the popular concern about "death panels," Roe replied: "Absolutely."" Jesanj (talk) 12:49, 23 February 2011 (UTC)

And, of course, Roe's language is derived from Palin. In the author's opinion "Republicans have also been egged on by Sarah Palin, who spawned the myth that the federal law would create "death panels" throughout the debate." After the White House concern, Palin's WSJ editorial, the FactCheck put down and the Mother Jones analysis, I'm not convinced this issue can be fairly excluded with your argument. Why not include a sentence that summarizes her WSJ editorial, the FactCheck check, and the MJ analysis? Jesanj (talk) 17:49, 23 February 2011 (UTC)

Holtz-Eakin

I propose the following text in the political debate section:

“ Douglas Holtz-Eakin, a former CBO director, thinks that despite "requirements that would force Congress to adopt the recommendations or find comparable savings", "cuts will be politically infeasible, as Congress is likely to continue regularly to override scheduled reductions". In Holtz-Eakin's view, no IPAB "will ever succeed in saving lawmakers from their own selfpreserving instincts to pander". ”

Jesanj (talk) 12:40, 25 February 2011 (UTC)

The whole section should be removed! WP is not a place where political debate is repeated. You may not like that, but it is simply not the case. Holtz-Eakin is now a politician as I understand matters and no longer the CBO director. His opinion is that of a regular politician and not an expert.Hauskalainen (talk) 23:55, 25 February 2011 (UTC)

Holtz-Eakin was published by Health Affairs and I also quote Susan Dentzer, the editor of Health Affairs, who summarizes his opinion so I disagree with you; you seem to be arguing that because he is no longer in government, he is no longer an expert. You're making up rules here, in my opinion. Jesanj (talk) 00:52, 26 February 2011 (UTC)

Not at all. I gave you the rule and that is factual information should come from non partisan experts and H-E is clearly partisan (he holds a senior position in the Republican party). WP is not a place for the airing of political debate.

There is another rule I should point out to you too. That is WP:SYN. You have taken two sentences from the article that are separated from each other and linked them together.

But to cut to the chase here, let's assume that you are claiming that he is still an expert because of his former job. what H-E is saying is that he does not believe the figures from the current CBO that the PPACA will reduce the deficit because he believes that congress will buckle under pressure at some time in the future and will pass A NEW LAW to prevent the IPAB recommendations from coming into effect. But he wants to amend the CBO numbers for the current law because he believes there will be a new law. Now as a former CBO director he of all people should know that this is not how it works. If congress later passes a NEW LAW that increases spending that is attributable to the NEW LAW and not the previous law! Its hard to say why Health Affairs did not challenge the pair on this prior to publication., Whatever the reason, it is disingenuous in the extreme to say that he believes new laws will be the result of the last law change but attribute the cost of the new law to the last law. Similarly with the so called doc fix. He wants the doc fix costs to be attributed to the PPACA but the PPACA does not include the doc fix. So it may be that H-E believes that costs will rise, but it won't be because of the IPAB it would be in spite of the IPAB because he has a cynical view of the action of congress. If he was an expert on the CBO he seems to have very quickly forgotten some very important rules. Maybe that is because he is now a party man. Look, I am a very reasonable editor, but if you insist on including his "beliefs" I will have to include balancing text as to why that "belief" is wrong, at least as far as how to attribute costs to changes in the law.Hauskalainen (talk) 17:36, 27 February 2011 (UTC)

I'm not sure what you have in mind belongs. It sounds like a WP:COAT so far, as you "know" H-E is wrong to express that opinion, while the editor of Health Affairs let it stand unchallenged... Please don't publish your own original research. Jesanj (talk) 17:42, 2 March 2011 (UTC)

I don't see what WP:COAT has to do with it. H-E says the CBO got it wrong because they did not include changes that are not included in the legislation. But CBO is quite right to do so. CBO is not allowed to speculate as to what future legislative changes may be made. And if they are made by congress they will be costed by CBO before they are legislated into law. All the stuff about those changes are speculation. Health Affairs has published H-E's opinion. But that does not mean that WP must also publish his speculations about the future direction of law. That breaches WP:CRYSTAL which say "Wikipedia is not a collection of unverifiable speculation. All articles about anticipated events must be verifiable, and the subject matter must be of sufficiently wide interest that it would merit an article if the event had already occurred." I would say that H-E's speculated future legislation is certainly not verifiable. Its pure conjecture and therefore completely unworthy of inclusion.Hauskalainen (talk) 23:47, 2 March 2011 (UTC)

H-E's opinion is verified in Health Affairs thus WP:CRYSTAL does not apply. You've already admitted that the text would be OK by saying "if you insist on including his 'beliefs' I will have to include balancing text as to why that 'belief' is wrong". Then insert your text (WP:PRESERVE) to make it WP:NPOV if relevant material has been published, as long as it follows policy. Jesanj (talk) 12:49, 3 March 2011 (UTC)

The opinions of Holtz-Eakin seem to be relevant given their detailed reasoning and his past position with the CBO. Intermittentgardener (talk) 13:13, 9 March 2011 (UTC)

References

Reduced influence from congress

The AMA president raised the issues of payment cuts and reduced congressional influence.[15] We could include these points perhaps. Also, I recall Uwe Reinhardt and a letter from lawmakers making the point that congress doesn't want its power reduced. Given the low approval ratings for congress, I would think there are articles with arguments supporting congress' power to be reduced by the IPAB. The reduced influence of congress seems to be a common theme in multiple sources. Perhaps eventually a section on this is warranted. Jesanj (talk) 14:09, 25 February 2011 (UTC)

To use a well-worn phrase (ex Mandy Rice-Davies), "he would say that, wouldn't he." Look its IPAB's job to get value for money for Medicare contributors and its the AMAs job to get more money for doctors. Of course there is a conflict their and they have settle their difference. But this is a natural process and certainly not very encyclopedic. Negotiations for the prices of things paid for by government go on all the time and are not worthy of inclusion in Wikipedia. They really are not. Congress can still block any IPAB decision so its powers are not really limited. To be frank with you, I suspect that most people in America would be shocked to discover that their congressmen and women determine the reimbursement rates paid to doctors. It is congress's job to make and repeal laws, not to determine the price of things. All IPAB is doing is shifting, in a very minor way to putting Medicare spending on the same basis as other government spending, So no, I disagree with you. You are just repeating political debate in Wikipedia and that is not what it is for. And I don't care how many sources you have for that.Its simply irrelevant. Hauskalainen (talk) 00:17, 26 February 2011 (UTC)

Let me know when you find the Wikipedia:Political debate should not be included from reliable sources, no matter how numerous they are policy or guideline. Jesanj (talk) 00:55, 26 February 2011 (UTC)

I can see that you are frustrated and your attempt at sarcasm has been spread a bit on the thick side. But the fact remains that WP is not here for the purpose of repeating political debate. We are here to provide factual information about topics to inform the reader using information gleaned from experts published by reliable sources. This article is about a body set up by law that has no track record because it does not even exist yet. The only factual information we have is what the law says, and what CBO expects. All the rest is conjecture and has no place in the encyclopedia. Hauskalainen (talk) 17:45, 27 February 2011 (UTC)

When reliable sources cover what organizations & experts fear/expect/hope out of this future board, covering and attributing those opinions is our duty under WP:NPOV, in my opinion. You appear to argue that no sources other than the law and the CBO are reliable for this page. I disagree. Perhaps you should take that opinion up at WP:RS/N. Jesanj (talk) 18:52, 27 February 2011 (UTC)

That is not true. I am following WP guidance which says OPINIONS should be the opinion of EXPERTS. You want to include partisan opinions provided by reliable sources. RS is a necessary requirement for inclusion in WP but it is not of itself a sufficient reason. We have a much higher standard for inclusion. Hauskalainen (talk) 16:12, 28 February 2011 (UTC)

What is not true? Again, it appears you are arguing the law and the CBO are the only reliable sources for this page. Is that your position? If so, then I recommend you take that up at WP:RS/N. Jesanj (talk) 16:22, 28 February 2011 (UTC)

It's not true that I argue that no sources other than the law and the CBO are reliable for this page. I said that that was the only source of reliable factual information that we have for the article, because everything else is speculation. As for the opinions about what may happen, Holtz-Eakin is now following his party's line and criticizing CBO for doing its job properly. He knows how the system works. If there are future laws they are costed against the future laws. Its quite wrong to argue that CBO missed out the doc fix and hypothetical and unknowable "what if Congress later changes its mind" potential costs in the CBO calculations for the Affordable Care Act budget impact. Holtz-Eakin is not an expert in Health Economics. I would say that a university health economist would, for example, be a neutral source for likely economic impacts. We have one from Reinhardt and he is hardly overflowing with praise for the potential of IPAB, but I have not objected to that reference. You fail to WP:AGF with my edits. However, I must be right in saying that everything that comes from people's opinions about what may happen, whether an expert or not, has to be pure speculation. Even CBO's estimates are best guesses but at least that has statutory authority and is trusted by Congess. The IPAB has yet to be appointed and its first recommendations are not due for some considerable time ahead. What ever opinion there is ought to be labeled as speculation and not fact. We should not include the opinions of people who are not experts (such as Palin) because that is simply not encyclopedic.Hauskalainen (talk) 17:43, 28 February 2011 (UTC)

So you no longer stand by the statement that "All the rest is conjecture and has no place in the encyclopedia"? Jesanj (talk) 18:42, 28 February 2011 (UTC)

(outdent) Yes I do stand by that statement. What we know about IPAB is the task that congress has set for it and all CBO has done is to assume what IPAB will achieve the reduction in the growth of spending. That is entirely logical and honest and fair presentation of factual information to our readers. All the other stuff you want to include is speculation because it is entirely unknowable at this stage. IPAB has not even be formed yet and so its very stupid as well as highly speculative to ponder the effect of its decisions when the decisions themselves are not yet known. Hauskalainen (talk) 20:07, 1 March 2011 (UTC)

We can present speculation in a fair, honest and factual way on Wikipedia. Jesanj (talk) 00:16, 2 March 2011 (UTC)

No we cannot unless the speculated events are highly likely to take place. See my earlier reference to WP.CRYSTAL which says "Wikipedia is not a collection of unverifiable speculation. All articles about anticipated events must be verifiable..." You want to include something that is highly speculative in the case of the article from Holtz-Eakin. The truth is that all we know is that the board has to look for ways to cut the growth in costs. There is an endless universe of things that IPAB may come up as ways to do this. The fact is that WP simply should wait until IPAB reports and it is wrong to speculate what they may be. Sure, people can speculate but it creates bias if we include some speculations and not others. Its best for WP to leave speculation to other web sites. Its not encyclopedic to be selective as to opinions. Hauskalainen (talk) 23:55, 2 March 2011 (UTC)

Your WP:CRYSTAL quote deals with unverifiable speculation, a sort we're not discussing. It also says "Predictions, speculation, forecasts and theories stated by reliable, expert sources or recognized entities in a field may be included" as long as we're neutral about it. Jesanj (talk) 12:53, 3 March 2011 (UTC)

Because he is not a reliable source. He has accused the CBO of not doing something that it is not allowed to do. Because he is not neutral either because he is an active Republican politician these days. Both these dent is credentials as a neutral expert. And it is stupid speculation because he has not even given a reason for believing what he said he thinks will happen. Its just another load of bollox that you keep adding to this article which is way way too long. It should only be a couple of pages long.

Hauskalainen, you are confusing the reliability of the person quoted with the reliability of the source reporting his words. You are still here filibustering the talk page and you are still engaged in a slow-motion edit war. Your behavior has really got to stop. Intermittentgardener (talk) 21:56, 7 March 2011 (UTC)

This dispute

As I understand it, the dispute about this article concerns including or not including information published in reliable sources that isn't "official" information, but rather consists of opinions an speculation by individuals who are notable, but possibly politically motivated. Correct?

I'll offer my view as a third opinion:

Like it or not, opinions can and do have a place in Wikipedia articles, if the opinions originate from someone with knowledge resulting from analysis or study. A reasoned argument from, say, an economics professor or insurance industry analyst is worth including.

Politically-motivated or ignorant opinions, even if they originate from notable people, may be worth including if actual reasoning can be found for them. The term "death panels" seems merely like name-calling to make a political/rhetorical point with no real argument behind it. I suppose such opinions could simply be summarized, with a few selected quotations, but one runs the risk of such a paragraph growing without bound as every editor with an agenda inserts a quote from their favorite critic. You'd need to establish an agreement on what constitutes a critic suitable for inclusion in the article.

See also Wikipedia:Mediation Cabal (less formal) or Wikipedia:Mediation Committee (more formal) for help in resolving your dispute. ~Amatulić (talk) 23:49, 28 February 2011 (UTC)

"...even from notable people..." I would agree if they are notable because of their expertise or even if they hold positions of real power (like President Obama or the leaders of the two main parties in congress who also hold powers of influence. But not any old politician who wants to sound off on a subject. That is not encyclopedic.Hauskalainen (talk) 20:15, 1 March 2011 (UTC)

Section blanking

Blanking out whole sections is rarely an appropriate way to handle concerns about content. If you see a problem you should re-write the content or flag it so that someone else can fix it. Intermittentgardener (talk) 17:34, 14 March 2011 (UTC)

If, when the material is subject to a content dispute, and with no attempted discussion, and no consensus, an editor involved in the dispute, appealing to emotion, replaces the content, I don't see a problem. Jesanj (talk) 00:38, 31 March 2011 (UTC)

I most definitely do see a problem. Blanking content just because you do not like it is not how things are done at Wikipedia. Blanking wholes sections is not acceptable except when dealing with copyright violations, vandalism, and negative content that violates the policy on biographies of living persons. Re-write the content, put a flag on it, or bring it up on the talk page. Wholesale deletions are a no-go and I will fight against them.Intermittentgardener (talk) 15:08, 31 March 2011 (UTC)

This essay exists, so I understand why you may disagree, but I don't want you to think you need to battle here. Above, I proposed a sentence. What do you think about that content? I don't see how an entire section is warranted. I've tried to discuss the relevance of this with you, but you haven't responded there either. Jesanj (talk) 18:34, 31 March 2011 (UTC)

The amount of text devoted to Death Panels section is entirely reasonable. This section is concise, contains all the relevant facts, and is even-handed. I just do not see any problem. I suspect that you just disagree with the the whole death panel smear and thus do not want it hear. Unfortunately, that is not how Wikipedia works. Our job is to faithfully recount what is in the sources.Intermittentgardener (talk) 11:45, 5 April 2011 (UTC)

No, it wasn't even handed. It was missing the FactCheck correction to Palin which found three flaws with her statement. Your suspicion isn't supported by what I've written above where I proposed a sentence. Your claims (reasonable, concise, all the relevant facts, even-handed) aren't bolstered with arguments by the way. Jesanj (talk) 11:55, 5 April 2011 (UTC)

I did not remove the Fact Check correction intentionally. I have re-added it. What evidence do you have that this sub-section is not concise, reasonable, and even-handed? It is short summary of the controversy that explains both sides of the argument without making a judgement. What more do you want?Intermittentgardener (talk) 10:41, 6 April 2011 (UTC)

I noticed that you removed the Death panels sub-section without making a note here and without mentioning anything in the edit summary. What was the point of flagging it if you were planning on doing that? I have re-added it along with the tag that you added. I suggest you read the tag in its entirety. I am beginning to suspect bad faith on your part. If you keep doing stuff like that my suspicions will be confirmed. I hope you prove me wrong.Intermittentgardener (talk) 11:51, 5 April 2011 (UTC)

I think it is worth reminding you that the only uninvolved editor who took a look at this thought including "death panel" stuff was unencyclopedic, by the way. Jesanj (talk) 12:24, 5 April 2011 (UTC)

I am aware of that but they are wrong. A very large amount of coverage was dedicated to the death panel flap. Major political controversies are certainly notable enough to warrant a small sub-section here. Also, I notice that you seem to be changing the subject and have not responded to my last comment. Section blanking is not acceptable.Intermittentgardener (talk) 10:32, 6 April 2011 (UTC)

Knowing that they are wrong isn't a position that demonstrates committment to a collaborative effort, in my opinion. The death panel myth was about an end-of-life care provision in HR3200. The section title of "Death panel controversy" misleads. Consider this: out of four people who have commented, you are the most passionate about including this amount of material; I find it inappropriate for you to unilaterally add the material. (For what it's worth, when I wrote some of that material into death panel, see discussion[16] it was obvious from my database search that it was a fringe/minority use of the term to use it for the IPAB.) Unfortunately, there appears to be a pattern of you adding POV section title headings ("Claims of Rationing" and "Consitutionality", discussed above) to this page. Jesanj (talk) 14:23, 7 April 2011 (UTC)

What is it about the headline "Death panel controversy" that misleads? Would putting Death panel in quotes make you feel better about it? The fact is that there is a controversy involving death panels and IPAB. I would also point out that I am not doing anything unilateral here. The current text was the product of at least three different editors.

As for those section headings, they are completely non-POV. "Claims of rationing" is a fair title. It does not pass judgement and makes it clear that the allegations about rationing are just that, merely claims. The same goes for "Constitutionality." Many people claim that IPAB is unconstitutional. Also, the title does not pass judgement. An example of a POV title might be "Unconstitutionality." "Constitutionality" is merely an accurate description of the topic. Finally, I found titles that are also Non-POV in response to concerns from other editors. All the content I have added has been reflective of the accounts in reliable sources.

You need to consider your own actions. Are you trying to keep this out because you think it detracts from the value of the article or because you simply wish to cover up controversy?

That said, stop section blanking. And please start being cooperative. I keep answering objections and making reasonable changes. You keep deleting and that is not appropriate.Intermittentgardener (talk) 11:07, 9 April 2011 (UTC)

Because you didn't hear me, maybe you should re-read what I wrote about why it misleads. To have a section title of "Claims of rationing" advances the position, in my opinion, that the IPAB may ration. Reliable sources and the law say it won't. We shouldn't use the claims of politicians or Rush Limbaugh (who do not qualify as reliable sources of information) to construct a section unless we have enough reliable sources documenting that this is an important topic relevant to the IPAB. Again, a section heading of "Constitutionality" advances, in my opinion, the POV that there is a question mark over the constitutionality of the IPAB. We would need reliable sources to do that in order to create a section, in my opinion, along the lines of my argument on your talk at the end of the section. And I don't think you identified or fixed a POV section title. I have no problem with an "Opposition" section as long as there is a "Support" section. You formed an Opposition section to which I added an to. Jesanj (talk) 20:18, 26 April 2011 (UTC)

POV tag

In my opinion, this article is too dedicated to collecting the opinions of those who oppose this entity while it excludes the opinions of those who support or have spoken positively towards the board. A Mother Jones article currently used as a source gives some detail on support from Congress and Uwe Reinhardt has spoken of the board's opportunity. Until we can get some more coverage of support, I think a neutrality tag is warranted. Jesanj (talk) 03:39, 24 March 2011 (UTC)

To make some progress, here is an article about Senator John D. Rockefeller IV and a list of economists, including three Nobel Laureates, who support the board.[17] Jesanj (talk) 17:36, 24 March 2011 (UTC)

It sounds like you have found your own solution. Why not just add the material that you feel is appropriate?Intermittentgardener (talk) 14:15, 25 March 2011 (UTC)

I guess I will if no one else does, sooner or later. If you could find some sources saying supportive things (and maybe even incorporate them) that would be reassuring, as, in my opinion, your efforts have tipped the scales. I doubt this one source would balance things out. Jesanj (talk) 00:27, 31 March 2011 (UTC)

The commentary on IPAB is just not very positive. IPAB's detractors have a lot more to say and have engaged in a lot more activity than its defenders and the current state of the article reflects that. NPOV is about accurately reproducing what is in the sources without inserting the opinions of editors. It is not about "equal time" where 50% of the space is devoted to each side of the debate. That said, if there is notable commentary on IPAB that is positive feel free to add it.Intermittentgardener (talk) 15:12, 31 March 2011 (UTC)

Hmmmm... "If there is notable commentary"?! I just said three nobel prize winners and a whole list of economists support the board. The NYT source includes a letter of support. Of course there is notable commentary, from serious, notable people... Jesanj (talk) 12:33, 5 April 2011 (UTC)

Add that material. I welcome it. No one is stopping you.Intermittentgardener (talk) 10:28, 6 April 2011 (UTC)

I'm not supportive of some sentences found in the "lobbying groups" section. These sentences and lengthy quotes are sourced to specialized trade journals such as Cardiology News, Internal Medicine News, and McKnight's Long Term Care News & Assisted Living. These publications aren't your normal reliable source. I don't think good research typically churns out these kinds of sources. A related problem I perceive with the page is that it also quotes politicians ad nauseam. Jesanj (talk) 21:31, 18 April 2011 (UTC)

Those are reputable industry publications. Any intensely political topic is going to involve lots of quotes from politicians, activists, and other stakeholders. It is just the nature of the beast.Intermittentgardener (talk) 16:13, 29 April 2011 (UTC)

Yes, I agree they are industry publications. And maybe they have a reputation for fact-checking after all. But they are highly specialized and absent of the weight as something like Health Affairs. I just see them as a small symptom of a larger problem with this article. And no political topic article requires "lots of quotes from politicians, activists, and other stakeholders". Jesanj (talk) 16:50, 29 April 2011 (UTC)

Here is some some positive commentary: "In line with that, it creates a body called the Independent Payment Advisory Board, which determines how much Medicare will spend annually. The American health-care system is riddled with waste and unnecessary and ineffective procedures. Relative to every other industrialized nation, we spend more and our health outcomes are no better (and often worse). In American medicine, supply often creates its own demand, and paying doctors on a fee-for-service basis encourages more high-cost procedures. The I.P.A.B., in conjunction with other cost-cutting provisions in the bill, would look to fix the skewed incentives that lead to overtreatment, bargain for better prices, and insure that we’re spending our money more effectively."[18] Jesanj (talk) 01:50, 30 April 2011 (UTC)

And mixed reception but overall positive from the Star Tribune: "Medicare board remains best bet" Jesanj (talk) 13:48, 12 May 2011 (UTC)

And "The Independent Payment Advisory Board—Congress’s “Good Deed”" was recently published in the NEJM by a Brookings Institution affiliate. Jesanj (talk) 14:04, 13 May 2011 (UTC)

Ezra Klein of the Washington Post said he thinks "the Independent Payment Advisory Board has a lot of promise as a way to control costs in Medicare. Perhaps more promise than anything else in the Affordable Care Act."[19]

The Washington Post editorializes that "We share Mr. Aaron’s aspirations for IPAB—it was a key factor in our endorsement of the health-care law—but we have less confidence that they will pan out. The board is hobbled by design: It can’t propose higher premiums or cost-sharing and can’t restrict benefits. Hospitals are off-limits until 2020. And that’s if IPAB is allowed to operate as designed. President Obama, in his recent debt reduction speech, recommended even more ambitious cost-control goals for IPAB along with 'strengthening' of the board."[20] Jesanj (talk) 20:24, 18 May 2011 (UTC)

Norman Ornstein of AEI said, "Many of the cost-control measures in the ACA came out of long-standing bipartisan consensus, with a large share originating in conservative policy circles. But all are being obdurately opposed by House Republicans--including the 42 freshmen who signed the plaintive letter--because they have declared a holy war on Obamacare, with designs on killing every element of it, whether good or bad. I could add the independent commission set to oversee Medicare to reduce the Congressional interference endemic up to now and to find good ways to reduce the fee-for-service-driven costs in the program."[21] Jesanj (talk) 04:34, 20 May 2011 (UTC)

The editorial board of USA Today has an article titled Medicare board does the dirty job Congress won't. Jesanj (talk) 15:33, 23 May 2011 (UTC)

POLITICO makes it sound as if experts have just started to think the IPAB is a good idea, but if we can get a copy of this letter it will be a valuable source for the article. Experts defend Medicare board and another article [22] Jesanj (talk) 17:14, 25 May 2011 (UTC)

Poll finds more trust in IPAB than Congress Jesanj (talk) 03:39, 7 July 2011 (UTC)

The Hill compares IPAB's mission to the bipartisan Senate gang of six plan. Jesanj (talk) 22:18, 28 July 2011 (UTC)

Edit warring over death panels

Ok, you folks have been reverting this back and forth for a month. Knock it off. I've protected the article for a month. If you can agree on mutually-acceptable wording before that, all the better.--SarekOfVulcan (talk) 15:04, 11 April 2011 (UTC)

QUESTION: HOW?

I am 71, a CPA, conservative, Tea Party member, lever pulling Republican and former CFO of a major teaching hospital. First in my opinion (first formed 40 years ago) Medical technology has surpassed society's ability to provide the current state of art technology to everyone. Therefore: we must have "death panels", or whatever you want to call them.

One time I had to choose to expand the neonatal intensive care beds, or establish regional walk-in clinics. We did not have money in the budget for both. I chose the clinics and therefore acted as a one man “death panel” for the babies that died because there was not an intensive care bed available for them.

My question: How is this INDEPENDENT ADVISORY BOARD going to “develop a proposal to reduce per capita Medicare spending without” including “any recommendation to ration health care, raise revenues or increase Medicare beneficiary premiums, increase Medicare beneficiary cost sharing (deductibles, coinsurance, or co-payments), or otherwise restrict benefits or modify eligibility criteria”.

Answer: reduce payments to medical providers and/or recommend that we “ration health care, raise revenues or increase Medicare beneficiary premiums, increase Medicare beneficiary cost sharing (deductibles, coinsurance, or co-payments), or otherwise restrict benefits or modify eligibility criteria”? Texbum —Preceding unsigned comment added by 75.140.243.180 (talk) 22:44, 20 April 2011 (UTC)

Presumably, the commission would enact some of the reforms that economists and other health policy experts have long advocated, such as moving health care away from the fee-for-service model. Thanks for your post but FYI talk pages aren't for our opinions. I do take your main point though, that the how isn't well explained in the article. Thanks again. Jesanj (talk) 22:55, 20 April 2011 (UTC)

And Palin's definition to a death panel requires a government body that rations based upon an individial's worth, something I doubt you did, but your point about existing rationing in the system leading to death is taken and acknowledged, I'd say. Jesanj (talk) 23:08, 20 April 2011 (UTC)

Not really relevant guys. We should report the debate and factual developments, not have our own debate.Intermittentgardener (talk) 15:46, 27 April 2011 (UTC)

Text-source integrity and on topic?

I removed some material and it was restored.[23] My rationale for removal was because the cited source does not appear to maintain text-source integrity and the other content looks off-topic. I'm unsure where the source says that 1) the IPAB was discussed during the 31 meetings 2) that the board was informally called "MedPAC on steroids". And wouldn't the second sentence be better off at the article on the Affordable Care Act? Jesanj (talk) 00:41, 20 June 2011 (UTC)

It is important to understanding the creation of IPAB to know that it started as a bipartisan proposal. The bipartisan roots of the Finance Committee proposal are doumented at the source cited. I know it to be true because I was in the room when it was discussed. I have trimmed it back to try to address the objection to the informal title. -- Dauster (talk) 11:11, 10 July 2011 (UTC)

Does the source say the IPAB started as a bipartisan proposal? If so, where? Jesanj (talk) 21:56, 12 July 2011 (UTC)

Yes, the source, Health Care Reform from Conception to Final Passage, discusses the bipartisan meetings that crafted the health care bill at the entry for June 17, 2009. Dauster (talk) 14:28, 20 July 2011 (UTC)

I think that would be a no, because I still don't see where it specifically mentions the commission. It's perfectly logical and to be expected that it was discussed. However, because we're supposed to avoid original research, I made this edit. I think it will satisfy us both. Thanks. Jesanj (talk) 15:03, 20 July 2011 (UTC)

CBO scoring

There is obviously room for improvement in the CBO scoring section. This was on NYT "The bill would yield less in the way of savings as a result of a new commission to recommend changes in Medicare spending. The commission, called the Independent Payment Advisory Board, is now expected to save $13.3 billion over 10 years, rather than the $28 billion in the Senate-passed bill."[24] And on May 13, 2011 the CBO estimated repealing the IPAB would cost 2.4 billion from 2018 to 2021.[25][26] Jesanj (talk) 23:05, 7 July 2011 (UTC)

Introductory Paragraphs

Original: The Independent Payment Advisory Board, or IPAB, is a fifteen-member, unelected United States Government agency created in 2010 by sections 3403 and 10320 of the Patient Protection and Affordable Care Act which has the explicit task of reducing the rate of growth in Medicare without affecting coverage or quality.[1] Under previous law, changes to Medicare reimbursement rates were recommended by MedPAC but required an act of congress to take effect, but the new system devolves responsibility to IPAB with the Congress being given the power to overrule the agency's decisions.

The Board is required to implement its first proposals in 2015 with its first report being produced by July 2014. The Chief Actuary of the Centers for Medicare and Medicaid Services will determine in particular years the projected per capita growth rate for Medicare for the second year thereafter. If the projection exceeds a target growth rate, IPAB must develop a proposal to reduce per capita Medicare spending.

Discussion of changes I will implement and those I think are needed:

I intend to delete "unelected" in the first sentence because it is superfluous and nonneutral. The only elected positions in the US Federal Government are the President, Vice President, and members of Congress. So, with the exception of the White House and Congress, every federal agency is run by unelected officials. Elected officials do have substantial responsibility for selecting the members of the board. They are to be nominated by the President based on recommendations from the four corners of Congressional leadership, and they must be confirmed by the Senate.

I intend to change "reimbursement" to "payment" because the former term is not neutral.

I intend to change "which has the explicit task of reducing the rate of growth in Medicare" to "which has the explicit task of achieving specified savings in Medicare." The former statement is a very common misunderstanding, which stems, I believe, from conflating the measures used to trigger action by the IPAB with the effect of any such action.[| see the CBO memo linked at the bottom of this article] The circumstances that will trigger action are based on the difference between two rate-of-growth measures--the five year moving average in the rate of growth in:

• A spending measure (Medicare spending per beneficiary), and
• An economic measure (for the first several years, the average of CPI-U and the Medical Services component of CPI-U; subsequently GDP/capita plus 1 percentage point).

The five-year moving averages will be calculated by the Chief Actuary of CMS using projected spending and economic measures for the year that is two years in the future compared to the actual spending and economic measures from the year that is three years in the past. (I will refer to the year that is two years in the future as the "implementation year" because that is the year in which the IPAB might be obligated to achieve savings.)

The requirement for the Board to act will be triggered if the spending measure exceeds the economic measure. The requirement, if triggered, is for the Board to achieve projected savings in the implementation year (as estimated by the Chief Actuary) that equal the difference between the spending and economic measures (in percentage points) applied to the Chief Actuary's projection of spending in the implementation year. A percentage applied to a dollar amount results in a savings target measured in dollars (that is, in terms of levels) and not in terms of growth rates. Moreover, the Board is under no obligation to reduce levels of spending in subsequent years. Thus, it is conceivable that actions by the Board affecting any given implementation year could have no effect on the level of spending (and thus no effect on rates of growth) in subsequent years.

If the requirement for the Board to act is triggered, it must submit its recommendations in January of the year before the implementation year. The first potential implementation year is 2015, so the first potential deadline for the Board to submit its recommendations is January, 2014.

The Board will not implement its recommendations; the Secretary of HHS will be required to do so.

More wordsmithing needed: The Board consists of 15 members; the agency will have a staff (the law authorizes the Board to employ staff and to use staff detailed from [that is, paid by] other federal agencies). Thus, "fifteen members" is accurate when referring to composition of the Board, but is not accurate when referring to the size of the agency.

MedPAC continues to exist and its role in advising Congress on Medicare policy was not changed by the legislation that created the IPAB. So the whole tone of the discussion of the relationship of the IPAB mechanism to MedPAC is off. Pl0rtn1pZ (talk) 02:58, 22 January 2012 (UTC)

Death panels and fact checkers

I added content saying that the "death panels" charge has been debunked, and cited two fact checkers. My changes were reverted with the comment: "numerous commentators have made the "death panel" charge, not just Palin." Why this is relevant is beyond my comprehension. Could someone please explain what was wrong with my addition? --Dr. Fleischman (talk) 22:42, 7 August 2013 (UTC)

You cite two sources. The first [27] never mentions IPAB, just says that Sarah Palin is wrong. The second [28] never mentions IPAB, just says that Betsy McCaughey and John Boehner are wrong. None of these people are cited in the section you edited, and all of the accusations in that section are specifically about IPAB. So in other words, you are presenting a rebuttal which doesn't correspond to the material you wish to rebut. If you have a source that says "IPAB is not a death panel," that would be appropriate. However, if you find one, I would not use that source to say that "the charge has been debunked" -- I would say that the charge has been rebutted. Joe Bodacious (talk) 13:53, 8 August 2013 (UTC)

Ah, thanks for the explanation, and you're right, those sources say nothing about IPAB. Actually, last night I did find a couple of sources that I believe satisfy your concerns. I'll find them again and add them in the next couple of days. If you believe they're still insufficient, instead of removing the language could you please add a cn tag and leave a note here? You'll see that I'm quite reasonable on these sorts of things. As for the "debunked" language I don't agree that "rebutted" would be sufficient but perhaps we can find some middle ground. --Dr. Fleischman (talk) 22:31, 8 August 2013 (UTC)

Dead Link

"Resource 17" has a dead link. I checked it out and think it should be replaced with http://www.nrlc.org/News_and_Views/Oct10/nv100110part2.html . Can I get confirmation for this?

The original, non-working link is: http://www.nrlc.org/news_and_views/Oct10/nv100110part2.html . — Preceding unsigned comment added by Lightvd (talk • contribs) 20:29, 9 August 2013 (UTC)

 Done --Dr. Fleischman (talk) 00:13, 10 August 2013 (UTC)