Whether you attribute the quote to Otto von Bismarck or Gustave Flaubert, many would agree with the sentiment that watching democracy in action is like watching sausage being made. The punchline is that while you may or may not like the result, the process will make you sick.
In that case, call the Independent Payment Advisory Board one of the sausages that came out of the process of creating the Patient Protection and Affordable Healthcare Act.
In case you forgot, the 15-member board will be comprised of doctors, nurses, medical experts, and consumers who recommend ways to reduce healthcare spending. They are allowed to analyze the drivers of Medicare cost growth and recommend policies to control Medicare costs if spending exceeds a targeted growth rate of 1% more than gross domestic product growth.
They haven't yet been appointed, and their first report to Congress isn't due until July 2014, but debates over their mandate are generating real fear—especially in the physician specialty arena.
Board members will be appointed by the president and must be confirmed by the Senate. The difference between this board and the other major board that recommends changes in Medicare policy, the Medicare Payment Advisory Commission, is that IPAB actually has the power to implement the changes it wants, with key — and very limiting — restrictions.
In fact, Congress must vote to block any of the Board's recommendations or they will automatically become policy.