Who wants to be a 'death panelist'?

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WASHINGTON -- Jonathan Gruber was one of the Obama administration's key advisers during the health care reform debate. As the economist who conceived the ideas at the heart of the Massachusetts health care law, he is arguably the intellectual godfather of the Affordable Care Act.

All of which would make him a natural fit for the Independent Payment Advisory Board, or IPAB, the new, 15-member panel that has the authority to reduce Medicare doctors' reimbursements and pilot new ways to deliver high-quality care for less. There's just one tiny problem: Mr. Gruber has absolutely no interest in serving on the panel.

"No way," he said without pause. "Maybe if it was a part-time gig. But full time? I can't see it."

It's not just Mr. Gruber. President Barack Obama's former health policy advisers worry that other top health economists, those in hot demand in academia and in the industry, won't be interested in a federal job where the compensation is comparatively low, the political controversy high and the ultimate payoff unclear. There is no set time for the appointments to be made, but the panel could be called into action as soon as this spring.

"It is supposed to be 15 members, with limited salaries, who can't do any outside work," said Peter Orszag, Mr. Obama's former Office of Budget and Management director, who was a key proponent of IPAB. "It will be challenging to find 15 top health care experts who would want that job."

"You're joining an organization that has uncertain authority with the certainty of being deeply political and widely criticized," said Robert Kocher, a former Obama health policy adviser. "It doesn't make sense for current thought leaders in American health care to want this."

The advisory board is one of the Affordable Care Act's most aggressive attempts at bending the health cost curve down. Its goal is to ensure that Medicare grows just 1 percentage point faster than the rest of the economy, much slower than historical trends. To get there, the board has the power to change the amount of Medicare's doctor payments. Until now, that authority has been held only by legislators. Unless Congress can recommend and pass an equally big set of spending reductions, the IPAB cuts take effect automatically.

The board has drawn heavy criticism since it became part of the health care law, with detractors referring to it as a "death panel" that would "ration" seniors' care. Even Democrats who staunchly support the Affordable Care Act have blasted the board as an unjustified power grab.

"The Independent Payment Advisory Board brings unpredictably and uncertainty to providers," said Rep. Allyson Schwartz, D-Pa., who has supported multiple bills to repeal establishment of the board altogether.

To become a member of this already-maligned board, health policy experts have to undergo what one former Senate aide described as a "super-double challenge": Meet the requirements set out in the law and then face confirmation hearings.

"It's not only the challenge of finding people who will serve, but also people who will serve and can get confirmed by the Senate," said Harvard professor John McDonough, who worked for the late Sen. Edward Kennedy, D-Mass., during the health reform debate.

The health law specifies that the board be made up of "individuals with national recognition for their expertise in health finance and economics, actuarial science," and related medical fields.

Members will serve a six-year term and during that time are barred from "any other business, vocation or employment." For their service, members will make an annual salary of $165,300, less than they would likely earn in the private sector or academia.

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