After every presidential inauguration, ambitious policy wonks scan a "plum book" of available appointments. But some jobs are more like prunes.
The mission of the 15-member panel is nothing less than saving the economy by slowing down the growth of Medicare spending, with the hope that slowdown will put a brake on the greater problem of runaway health spending.
The IPAB will have the say-so to cut doctor reimbursements and find new ways to deliver health care at lower costs. Its recommendations win by default unless Congress can muster the votes to pass an alternative approach to keep spending in check.
Here's what health and budget experts tell Kliff about the jobs:
"It is supposed to be 15 members with limited salaries who can't do any outside work," says Peter Orszag, the former director of the Office of Budget and Management under Obama, who was a key proponent of IPAB. "It will be challenging to find top 15 health-care experts are who would want that job."
"You're joining an organization that has uncertain authority with the certainty of being deeply political and widely criticized," says Bob Kocher, a former Obama health policy adviser. "It doesn't make sense for current thought leaders in American health care to want this."
And those are the people who support President Obama's Affordable Care Act, which established the panel.
Conservatives have had a field day criticizing the unelected board as too powerful. Many health industry trade groups hate it - not coincidentally because it could cut money for their medical providers. And some critics have even taken to calling it a "death panel," saying its decisions about spending cuts could hurt Medicare patients.
Can't imagine why people don't want the job.