how is/was that currently handled with medicare?

Medicare/aid, as well as the rest of the insurance industry, sets 90% of their prices based on RUC. The IPAB was created to improve upon the RUC, while leaving it still in place.

The RUC is a bad process and adding another layer on top of it does not fix the problem. The entire pricing methodology needs to be tossed out.

I am not one that considers the IPAB the same as a death panel or that it will necessarily lead to such. That being said, I am not opposed to an Advisory Board recommending that we have exhausted all necessary and relevant care for a person and any further expenses and procedures would not necessarily add quality life. From that point, it could be up to the patient and the patient's family to continue care vs. the blank check of the fed.

The removal of any lifetime caps by the ACA only makes this problem infinately worse.

I think we can all invision a day when someone's care will cost of well over $1,000,000 - and there is nothing in place to cap that cost.