Grasping at Thin Straws: That Kaiser IPAB Poll

Before we delve into this, let’s start with some basic, but essential, information.  A CBS News/New York Times poll conducted in late June established Congress’s approval-disapproval rating at 20-70.  That’s actually a high water mark compared to a December 2010 Gallup poll that said only 13 percent of the country approved of Congress’s job performance, compared to 83 percent disapproving.

Keep those numbers in mind as we discuss the Kaiser Family Foundation’s June tracking survey, a poll that proponents of the Independent Payment Advisory Board (IPAB) are touting as evidence that Americans are rejecting criticisms of IPAB.

Or, as Washington Post blogger Greg Sargent put it, “we now have our first poll that shows pretty clearly that the public isn’t buying the attacks.”

But is the Kaiser survey really so clear regarding public sentiment toward IPAB?   In the Kaiser tracking poll, there is only one question dedicated to the issue.  It was phrased as follows:  “How much would you trust an independent panel of full time experts appointed by the President and confirmed by the Senate to make proposals about ways to reduce Medicare spending and keep the program sustainable in the future?  A great deal, a fair amount, just a little, or not at all?”  Other iterations of the question substitute “Congress”, “private insurance companies” and “the federal agency that now runs Medicare” for the independent panel.

The results that made headlines show that 50 percent of the public trusts IPAB a great deal or a fair amount, compared to 34 percent trusting Congress.

Some observations:

1)      Remember those congressional approval ratings I mentioned in the first paragraph?  Essentially the public is being asked to choose between an institution they adamantly dislike and what’s behind the mystery box?  Given such high public disapproval of the legislative branch, the only wonder is that the mystery box didn’t win by a bigger margin.

2)      Only 15 percent of those surveyed, or less than one of every six Americans, said they support the “independent board” a great deal.  That’s not exactly a rousing vote of confidence.  The 34 percent who said they support IPAB “a fair amount” is probably as much an indication of the favorable description given the board in the survey question as it is genuine approval of the concept.

3)      Speaking of that description, one can’t help but wonder how the public would respond if told that the implementation of IPAB recommendations would not be subject to judicial review, or that the statute makes it extremely difficult for Congress to overturn those recommendations, or that the way IPAB is structured means that its budget-cutting ax will almost certainly fall upon provider payments?  If the public knew that this “independent board” would likely compel more physicians to see fewer Medicare patients, where would that approval rating be?

4)      Voters elect members of Congress to make decisions on issues like the future of Medicare.  Since when is a monthly tracking poll justification for shifting that constitutional responsibility over to a non-elected board?

Let’s be clear.  This post is not intended to be a criticism of the excellent work the Kaiser Family Foundation does on its monthly healthcare tracking surveys.  Rather, I’m amused that some of the same people and organizations who dismiss negative polls about the Affordable Care Act are so quick to grab hold of this rather thin straw.