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GOP opposes its own goals on Medicare

Imagine a strange conversation in which a Republican leader tells a Democratic leader, "I demand that you do something to rein in Medicare spending." The Democrat responds, "Sure, we'll create an Independent Payment Advisory Board which will help reduce costs." To which the GOP leader responds, "I'm outraged by our efforts to rein in Medicare spending."

Now imagine the strange conversation is true.

House Republicans signaled Thursday they will not follow rules in President Obama's healthcare law that were designed to speed Medicare cuts through Congress.

The House is set to vote Thursday afternoon on rules for the 113th Congress. The rules package says the House won't comply with fast-track procedures for the Independent Payment Advisory Board (IPAB) -- a controversial cost-cutting board Republicans have long resisted.

The rules package signals that Republicans might not bring up Medicare cuts recommended by the IPAB -- blocking part of a politically controversial law, and resisting Medicare spending cuts.

So, Republicans desperately want Democrats to accept policies that curtail Medicare costs, except when Democrats actually take steps to curtail Medicare costs? Yep, that's pretty much what's happening on Capitol Hill.

As Ed Kilgore explained, "What's really maddening is that IPAB -- following the overall thrust of Obamacare -- is designed to secure savings not just for Medicare but for the entire health care system by encouraging better medicine, not reductions in health coverage for seniors. It seems Republicans are only interested in health care cost containment measures or 'entitlement reform' if it comes at the expense of beneficiaries."

Quite right. The rule is crass but simple: for Republicans, entitlement savings only count if Americans receiving the benefits are forced to struggle, at least a little.

If beneficiaries aren't sacrificing, then Democrats aren't playing by the rules, and their efforts to save taxpayer money deserve to be ignored.

I realize IPAB may seem like a relatively obscure part of the larger health care law, so in case anyone needs a refresher, let's quickly recap.

As Paul Krugman explained a while back, "Arguably the most important thing we can do to limit the growth in health care costs is learning to say no; we cannot afford a system in which Medicare in particular will pay for anything, especially when that's combined with an industry structure that gives providers a strong financial incentive to engage in excessive care."

As we discussed in June, the Obama administration seeks to solve this problem through IPAB -- putting the difficult decisions in the hands of qualified medical and health care professionals, free of the political process on Capitol Hill. And why is this necessary? In large part because Congress has failed so spectacularly in its ability to make these choices on its own.

In theory, Republicans should be delighted -- we're talking about a panel tasked with cutting entitlement spending and saving money. But in this case, GOP officials say they want to lower costs and cut spending, but also oppose a panel that would lower costs and cut spending.

Entitlement "reforms" are likely to be pretty difficult given Republicans' approach.